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Have mild hypogonadism, swollen lymph node in neck. STD negative. Should I go for inguinal node biopsy?

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Practicing since : 2002
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Having some health issues relating to Hematology, Rheumatology & Dermatology... any advice or suggestions is welcome. My team of physicians has yet to diagnose me.

Feb 2012- Enlarged painless left inguinal node with hydroceles in both testicles (testicular ultrasound findings)
Lymph node recessed after a couple of weeks - no infection was found
Chiropractor advised of granulomas in both lungs in x-rays & asked about any serious lung infections (haven't had any)
XXXXXXX 2012 - Dr observed Eosinophils were elevated (has resolved)
All STD screenings - Negative
Mild Hypogonadism diagnosed

July 2012-present - skin lesions on dorsum of hands, top of right leg, left elbow on forearm, occipital scalp, face/hairline
3 biopsies - no organism found as the cause. (fungal-negative, mycobacterium-negative, bacterial cultures negative, parasite-negative)
Biopsy in october - pathology report states: Basal layer necrosis with deep superficial and perivascular lymphocytic infiltrate with a few eosinophils consistent with hypersensitivity from XXXXXXX or external agent.
Sept 2012- Reynaud's phenomenon began in hands/feet - cold/numb in 4th & 5th digits
Mild evidence of bleeding into nail folds & eponychium in fingers

Oct 2012- High BUN ratio & low alkaline phosphatase
Nov 2012- BUN/Creatinine Ratio- 23.3, Alkaline Phosphatase 40U/L, AST 21 U/L, ALT 29 U/L, SED rate 2mm/hr, Urea Nitrogen 18mg/dL, Creatinine 0.77mg/dL, Sodium 140mEq/L, Potassium 3.9mEq/L, Chloride 104 mEq/L, Carbon Dioxide 28mmol/L, Calcium 8.8mg/dL, Protein 6.7g/dL, Albumin 4.5g/dL, Bilirubin 0.5mg/dL

Dec 2012- 4.7thou/uL WBC, 5.08mil/uL, Hemoglobin 15.9g/dL, Hematocrit 45%, MCV 88fL, MCH 31.3pg, MCHC 35.7g/dL, RDW 11.4%, Platelet 181 thou/uL, MPV 9.6fL
Dec 2012- Tested for autoimmune conditions. ANA- Neg, RF 9 IU/mL, Anti-DNA(SLE) 7 IU/mL, ANCA-negative, Anti-myeloperoxidase 1.74EU/mL, Anti-Protease 2.01 EU/mL, CH50Blood 271 CH50 U,
Biopsies continued to be inconclusive.
All STD screenings negative
XXXXXXX 4 2012- Presented at dermatology grand rounds @ Vanderbilt - Overall opinion was folliculitis XXXXXXX 2012- Nutritional studies conducted. Zinc Serum 56 ug/dL, Vitamin B1 79nmol/L, Vit B2 18nmol/L, Iron Blood 166mcg/dL
Treated with 50mg Zinc Gluconate/day to correct Hypozincemia
Reduced Iron intake.
XXXXXXX - CT scan w/ Contrast of Pelvis-
nothing remarkable was found.
XXXXXXX 31 - Infectious Disease consult
CBC- 3.7thou/uL , RBC 4.87mil/uL, Hemoglobin 15.5g/dL, Hematocrit 44.8%, MCV 91.9fL, MCH 31.9pg, MCHC 34.7pg, RDW 12.8%, Platelet 200 thou/uL
Alkaline Phosphatase 37, AST 23 U/L, ALT 30 U/L, SED rate 2mm/hr, BUN Creatinine Ratio 20.9, Sodium 141 mmol/L, Potassium 4.4 mmol/L, Chloride 106 mmol/L, Carbon Dioxide 23 mmol/L, Calcium 9.4mg/dL, Protein 7.1g/dL, Albumin 4.7 g/dL, Globulin 2.4g/dL, Bilirubin 0.5mg/dL, Uric Acid 5.7 mg/dL, Creatinine Kinase 52 U/L,
Anti-teichoic acid antibodies- 1:2H
Treated with Zyvox 600mg/BID & Rifampin 300mg/BID, Mupirocin topically for lesions on hands/scalp.
45 days of treatment - did not resolve issue.
WBC count elevated to 4.1 during Zyvox treatment.
HIV 1/2 EIA w/Reflex- Non Reactive
RPR w/ Reflex & titre- Non Reactive

March 2012- Zinc Serum 72ug/dL, Iron Blood 101 mcg/dL, Binding Capacity 260mcg/dL, % Iron Saturation 39%, Ferritin Blood 93 ng/dL

March 28, 2012-
WBC 3.8 thou/uL- Inguinal lymphadenopathy with about 7 or 8 medium size nodes some feel solid -Lymph nodes in neck have grown over past few months & now feel a chain of about 6 nodes in left side sent to surgeon for inguinal node biopsy.

Symptoms that have come & gone over past year-
Night sweats (seems to be worse in my pelvic area) but i wake up damp & feels like I have wet the bed.
Difficultly sleeping but very fatigued
Abdominal Pain/Bloating
Frequent Headaches
Shortness of breath (not all the time)
Lesions on inside of bottom lip that resolve after a couple days
Joint pain in hips/wrists
Sudden urge to urinate with little warning has happened on several occasions.
Persistent lower than normal blood counts

They are wanting to do inguinal node biopsy due to the gradual increase in size of the lymph nodes
Neck lymph nodes are also palpable and have been for several months, should I request they biopsy node from neck?
I have asked to see hematology for consult before going for biopsy - haven't heard back yet.

Any thoughts or advice? Surgeon warned of potential lymphedema in right leg & chance of edema in my hip area as a result of procedure.

Thank you for your help!
Posted Fri, 26 Apr 2013 in Blood Disorders
Answered by Dr. Robert Galamaga 9 hours later
Hello and thanks for the query.

I can appreciate that you are likely frustrated by the chronic nature of what you have been dealing with with really no unifying diagnosis.

I can say however that at this point there does not appear to be any active blood or lymphatic cancer or disorder going on. I think it is reasonable to perform the lymph node biopsy and idelaly this would be an excisional biopsy where an entire lymph node can be sent to a pathologist for analysis. This would help to rule out a possible low grade lymphoma.

Your skin lesions are unusual and I am not able to postulate the exact origin of these other than potentially some type of reaction or hypersensitivity. You have had this worked up extensively it appears by expert dermatologists.

I think it would be reasonable for you to consult with a hematologist who can review your tests and scans and discuss the biopsy results. I think the risk of lymphedema is limited with an excision of a few nodes but of course it is not zero.

If you're having issues with sleeping and headaches I would suggest weaning off of the adderall.

Also, it is critical that you maintain a good well balanced diet with good aerobic exercise for at least 45 minutes 5 days per week.

Again, I see no sign of malignancy at this time or blood cell disorder.

Thanks again for sending the query. Please let me know if you have any specific concerns in followup.


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: Have mild hypogonadism, swollen lymph node in neck. STD negative. Should I go for inguinal node biopsy? 7 hours later
I just went and had a pelvic & testicular ultrasound and have images available of it. the largest node is 6cm long, another that is almost 5cm long and have several that are between 1-4cm.

They are scheduling me for inguinal lymph node biopsy next week.

Thanks for your input.
Answered by Dr. Robert Galamaga 16 hours later
Hello and thank you for the follow up information and images.

I think it is absolutely reasonable to biopsy one or more of these lymph nodes to get an accurate diagnosis at this time.

Again larger than normal lymph nodes do not always reflect some type of cancer. The pathologist needs to carefully examined the lymph node to see if there's any process going on.

Please keep us posted regarding the results of the biopsy. Thank you again for sharing your health concerns with us.


Dr. Galamaga
Above answer was peer-reviewed by
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