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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is recurrence of mononucleosis a sign of an autoimmune disease?

Answered by
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Dr. Monika Dede

Infectious Diseases Specialist

Practicing since :2003

Answered : 866 Questions

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Posted on Fri, 3 Aug 2018 in Lump
Question: What can cause reoccurrences of Mono? Can my daughter possibly have an autoimmune disease that they need to test for?

I thought I might need to give you a medical history so you would know a little bit more about her to better diagnose. My daughter has a history of Polycistic Ovarian Syndrome, and is insulin resistant. She takes Metformin twice/day. She sees an Endocrinologist in XXXXXXX TN at Children's Hospital every 6 months to keep check on this. She also sees an OBGYN locally for consultation & blood work -every 6 weeks to help with heavy menstrual cycles & migraines. He prescribed Yaz that she takes every month. The PCOS also causes severe acne. She sees Dr. Hanson- Dermatologist & he has her taking Amnesteem right now 1/day. She recently started on a new medicine to help her with her migraines and weight gain under the supervision of Dr. Wakefield at OBGYN- Qsymia (which is made up of Phentermine 15mg (appetite suppressant), Topiramate 50mg(migraine medication)Vitamin D3, & Chromium (2,000IU) ) she takes 1 pill/ day. She has currently been migraine free for almost 2 months and has lost almost 15 lbs. Her current weight is 214. She was diagnosed with P.C.O.S. at the age of 12 but there wasn't a diet medication that was safe for her until the age of 15 so we have just been trying our best to do the low carb high protein drinking lots of water plan until then. Her weight just kept going up & down. Her sugar craving was very difficult but it is now under control on this new medication with Dr. Wakefield thank goodness for him. Now if I can just find out why she continues to keep getting run down with Mono. This time it's worse than the previous times so they have scheduled an ultrasound of her abdomen for her spleen, gallbladder, liver. She keeps complaining of her stomach hurting her near her gallbladder when the doctor examined her. She also gets bad heartburn acid reflux issues at night which I know personally is related to the gallbladder. Is this an effect of Mono too? She woke me up at around 2:30 a.m. Tuesday night/Wednesday morning with her stomach hurting and feeling bad all over. Her head hurt and achy all over. She was dizzy. I checked her temp but it was normal. She had an upset stomach so I assumed she was coming down with the stomach virus that was going around in our town. She told me she felt like she was going to be sick as in nauseous. I kept her home from school. By Wednesday night she was hurting all over in her joints too. She said her body was aching but she never vomited. We kept her diet to a minimum, sipping on water, saltine crackers to nibble on afraid she would get sick. She ate some chicken noodle soup. Kept her temp checked no fever. I knew the doctor office couldn't do anything for a stomach virus. By Thursday afternoon she couldn't hold her head up and her hands were shaky so I was then afraid she may could possibly have the Flu even though she didn't have a fever, she has had the Flu before with no fever to start. She has just been so exhausted not wanting to get out of bed but with added symptoms this time a little different than her previous Mono diagnoses of total exhaustion/dehydration feeling I didn't think it was Mono this time since it seemed more like the Flu. I took her to the Urgent Care clinic & they did test her for the Flu but it was negative. When I told them her history of Mono they tested for that too and did the test twice. Positive automatically both times within seconds. When I told them how many times she has been diagnosed they told me we needed to get her spleen checked and to go ahead and get her gallbladder checked since she's have abdominal pain too.

I just want to make sure that there might not be something else going on that the Nurse Practioner at the clinic might be missing because she had a look on her face like she just wasn't sure. She was going by the test results. They didn't even draw blood from my daughter's arm. They pricked her finger to get her blood for the tests. She ended up having to get 4 different fingers pricked to get enough blood. I couldn't get her in to our regular doctor because they were covered up with patients and didn't have any openings. I couldn't afford to go to the E.R. and personally I don't do that unless it's a life-threatening emergency. I wish they would have a M.D. at every Urgent Care Clinic too.
doctor
Answered by Dr. Monika Dede 4 hours later
Brief Answer:
I need to see some test results for mono.

Detailed Answer:
Hello,
Thank you writing i healthcare magic.

Please could you tell me what kind of test they have done for mono( EBV IgG and IGG or monotest) and if she has done a full blood count , ERS ,and AST , ALT , electrolites?
I think that this situation is not related to mononucleosis but I need to see the results of the above mentioned tests to define better the diagnosis.


I hope my answer helps you.
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Monika Dede 2 days later
I'm sorry I didn't get to answer your question. I was at work when I sent the request to you. The doctor's office called so I had to leave work. They got my daughter an appointment at the hospital for an ultrasound of her abdomen. They checked her spleen, liver, gallbladder, kidneys They called me with results Friday afternoon and told me all was normal. I then requested to know why my daughter keeps getting sick and they (the Urgent Care) told me to follow up with our regular doctor office and request blood work to check if I still insisted to check for autoimmune diseases. I tried to call our doctor office to get an appointment but forgot they close up early on Friday. They close by 12:00 noon. I left a message that I wanted to bring my daughter in today for blood work and for them to check her and that I had to take her to the local Killen Urgent Care due to I couldn't get through to their phone line on Thursday and let them know that she tested positive twice for Mono after they did blood tests. I had the Urgent Care fax all test results to our doctor's office. I don't have the actual physical copies of the tests but I will go by there today and get copies. They've been covered up with Flu patients & stomach virus so it took me a while just to hear results from our ultrasound. My daughter's temp has stayed around 100.3, 99.4. I have given her ibuprofen or Tylenol in rotation as directed. Keeping her hydrated. She doesn't feel like eating much. She still feel horrible. Her lymph nodes feel more swollen today in her neck area. Her head hurts. She feels nauseated still.

Do you recommend when we go to the doctor office this afternoon that we get them to do a full blood work to check for any autoimmune issues? What is ERS, AST, ALT ?? All I know is when the nurse & the Nurse Practioner saw her Thursday after taking her blood said the Mono test was positive twice. They took blood from her finger prick & squeezed it into a tiny vile that was made into a small card type thing. The nurse kept saying she had to get enough into it for the test and that's how they did it instead of taking blood with a needle from the arm?? She had to prick 3 different fingers which we would've been happier with them just taking a tube of blood from her arm.

She (the Nurse Practioner) did make a comment that the 1st Mono test that they did had a "funny weird reading" which I thought was strange. That's why they tested her 3 times & got 2 postives.


Please Advise.

Thanks
doctor
Answered by Dr. Monika Dede 22 hours later
Brief Answer:
She should do a limph nodules byopsi.

Detailed Answer:
Hello,
I am sorry for my late response.

Based on these data I suggest to do a lymph nodules byopsi to define better the diagnosis. I think this is not related with autoimmunity diseases. Did she has done a CMV and toxoplasmosis serology?
ERS is eritrosedimentation, AST ALT are liver enzymes to check liver function.

I hope my answer helps you.
Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Monika Dede 1 hour later
Thank you for your response. I took my daughter to see her regular doctor yesterday at 3:30 p.m. and she examined her. They took 2 tubes of blood from her arm and reassured me they will run tests to check her liver enzymes/white blood count/red blood count (Sed Rate) I guess that's what you were referring to with the ERS and she wanted to check for anemia and also do a more thorough Mono testing instead of just the type that the other clinic (Killen Urgent Care) did where they did the finger stick and put her blood in the tube in the card to use for testing. She said they will let me know results as soon as they get them today and will request blood sent to the CDC (Center Disease Control) for testing if needed according to the results that she gets. She seemed very concerned about my daughter too. Her lymph nodes are very swollen in her neck, she continues to ache all over & in her joints & her back. She's nauseous. She had pain of soreness on examination when she was pressing on her upper stomach/gall bladder area. Keeping Low grade temp of 99-100.3. Constant headache. Exhaustion. When you look in her eyes she looks like she's about to just pass out. Very pale. She told her she needed to continue bed rest and needed to continue to stay home from school until we know what we are dealing with. I will let you know what I find out from the test results.

I appreciate your advice.

Stacie Strait
doctor
Answered by Dr. Monika Dede 27 hours later
Brief Answer:
Please let me know about the lab results.

Detailed Answer:
Hello,
I am sorry for my late response.

Please let me know about the lab results to define better the diagnosis.

I wish your daughter a quick recovery.
Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Monika Dede 14 days later
My daughter is scheduled for surgery next Friday Feb. 2nd for tonsillectomy & adenoidectomy. She had tonsil stones removed on one of her tonsils yesterday (one was just removed on XXXXXXX 11th), she still has been feeling bad with swollen lymph nodes in her neck & sore throat & hard to even swallow water. Still having exhaustion issues from Mono symptoms but is now testing negative for that. Recovering from sinus infection where she was diagnosed on XXXXXXX 10th after going to the 3rd clinic to be seen at Med Plus which was more like a regular doctor office with in-house xray/lab & MD's on hand instead of Nurse Practioners. The doctor who saw her yesterday XXXXXXX 23rd is a ENT specialist. The reason we got apt with him was because she started having nosebleeds Sunday XXXXXXX 21st & after he reviewed all of her history & symptoms he recommended surgery.

How do you feel about this surgery to help prevent her symptoms?
doctor
Answered by Dr. Monika Dede 23 hours later
Brief Answer:
It is a good news that she has the negative result of Mono.

Detailed Answer:
Hello,
I am sorry for my late response.

I have read carefully the above history but I am not able to judge and define if this surgery can help prevent her symptoms because I am an ID specialist.

Furthermore, I think it is a good news that she has a negative result of mono.

I hope my answer helps you.
Regards.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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The User accepted the expert's answer

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