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Noticed supraclavicular lump, low fever, night sweats, losing weight and brownish color urine. Worrisome

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Posted on Tue, 19 Feb 2013
Question: On May 12th I noticed a supraclavicular lump. Three days later, I developed low-grade fevers, night sweats, and I noticed that I lost 10 pounds in a month. Because of my PPO I ordered a CT scan right away, which came back all clear except a 1 cm borderline node in my abdomen and a 4mm thyroid nodule. I then pushed for an excisional biopsy. Fortunately the pathology results were reactive and showed no cancer. My symptoms peaked the first two weeks, May 15th-May 25th or so. Neck and jaw stiffness and inflammation - not noticeable swelling but it felt like it. Also lots of aches and pains throughout my body, especially lower back, random places. My arms felt tired and weak like my lymph system was congested but my muscles were fine. I didn't feel any general fatigue. Strangely, there were NO respiratory symptoms, no sore throat, or any kind of coughing or sinus congestion.

For one week around May 22nd-May29th I had small pricks of blood under my skin, kind of like a mild petechiae, all over my neck, which persisted for a week before fading. Small patches of petechiae appeared on my left arm briefly too.

After the first two weeks I felt congested inner ears, but an ENT said he found no ear infection. It felt like an ear infection through. Then I had tinnitus off and on, even now two months later I have some occasional tinnitus.

In XXXXXXX my ear congestion subsided and the aches/arm fatigue went away but sometimes I still feel unnatural small shooting pains occasionally in random places in my body. Also, most worrisome, I've developed a dull throbbing headache mostly behind my left eye but also generally, kind of like a sinus headache, in the last one or two weeks. It is an intermittent headache which comes and goes - and I have NEVER had migraines or headaches in my life. Is this a brain tumor or a post-infection headache?

My urine is also an off brownish color. However, I have had NO abdominal pain.

Then, the past two days, I developed a disturbing bumpy red petechiae rash on the fingertips of my left thumb, and on my right pinky? It is a swelling on the sides of the finger tips, bumpy, with red petechiae on the bumps. It is not itchy, just inflamed. I hope it doesn't spread.

Still some minor pains in my ears occasionally throughout the day. Also, my night sweats stopped for a week but most worryingly, my night sweats returned and persisted. They have never been drenching night sweats but I wake up at exactly the same time every night feeling damp. I also have sleep apnea now, waking up in the middle of the night like this like clockwork!

I had three blood tests. The first, during the peak of my symptoms, showed very high neutrophils, everything else normal. The second blood test, a week later, showed normal neutrophils and raised monocytes, as if from bacterial infection. I'm waiting on results for a third I had recently.

I am extremely worried because the weight loss and continued night sweats over a month later point to some kind of cancer? But wouldn't it have shown up on the CT scan? And the excisional biopsy said it was not lymphoma?

I am waiting on a monospot and EBV spot test, but what other viral tests can I take??? This seems serious, almost like lupus but I don't have a butterfly rash on my face.

Your advice is appreciated.
doctor
Answered by Dr. Ketan Vagholkar (4 hours later)

Hi,

Thanks for providing a detailed account of your medical problems.

It seems the multitudes of your symptoms are spread across the whole body. It might need a multidisciplinary treatment.
However it is essential that we rule out lymphomas completely first. The description you have provided are suggestive of lymphomas. Further biopsy diagnosis of reactive can be quite deceptive. I would suggest the following:
1. Review of slides by a hemato-oncologist.
2. Immunohistochemistry of the biopsy material.
3. Culture of the part of the biopsy material or a fresh biopsy specimen for atypical mycobacterial disease.
4. Electrophoresis of urine for multiple myeloma.

My intention is not to create, but again we also should not be complacent in handling this situation. Consult a hematooncologist if you haven't met one yet and discuss about your problems and the aforementioned investigations.

I hope this provides guideline for further investigation. If you have any other concerns, I will be happy to address them.

With regards

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ketan Vagholkar (13 days later)
Thank you for this informative followup. My initial appointments were all with a hemato-oncologist. However I am now going to try to find a doctor or another hemato-oncologist who can perform the tests you mentioned. I am afraid my sample was so small and it's been so long that it cannot be tested on as you described. I have no other enlarged lymph nodes to biopsy and the one in my abdomen, which I hope hasn't grown, was too XXXXXXX to access.

Since the end of XXXXXXX my previous symptoms all disappeared, however my headache became so severe it lasted a week and I had incredible pressure in my head and ringing in my ears. I immediately had an MRI with contrast, and my neurologist said my MRI came back normal.

At this point in time, except for the occasional ringing in my left ear and some popping in my right ear, I feel perfectly normal again, no detectable symptoms.

However, cancer symptoms CAN be cyclical, as I have heard. The only problem is trying to perform further tests on a small, old sample.
I also want to mention that I had two or three more blood tests which showed no abnormal counts, in addition to a urine test. But the lab just said the urine test came back normal. I will have to follow up with the lab to see if they can re-run a urine test for electrophoresis? Perhaps that is not a specific test they do in normal urine tests.
doctor
Answered by Dr. Ketan Vagholkar (9 hours later)
Hi,
thanks for th feedback.
I am happy to learn that all your major test results were normal and there has been regression of all your symptoms except the ear problem.
For the ear symptoms I would suggest an ENT check up. In view of your past history of ear infections there is likelihood of there being a fall out of those infections.
If all the existing tests are normal and your symptoms have also disappeared then you need not worry about the hematological problems at all.
I hope this answers your querry.
If you still have any doubts kindly write back to me.
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ketan Vagholkar

Gastroenterologist, Surgical

Practicing since :1989

Answered : 883 Questions

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Noticed supraclavicular lump, low fever, night sweats, losing weight and brownish color urine. Worrisome


Hi,

Thanks for providing a detailed account of your medical problems.

It seems the multitudes of your symptoms are spread across the whole body. It might need a multidisciplinary treatment.
However it is essential that we rule out lymphomas completely first. The description you have provided are suggestive of lymphomas. Further biopsy diagnosis of reactive can be quite deceptive. I would suggest the following:
1. Review of slides by a hemato-oncologist.
2. Immunohistochemistry of the biopsy material.
3. Culture of the part of the biopsy material or a fresh biopsy specimen for atypical mycobacterial disease.
4. Electrophoresis of urine for multiple myeloma.

My intention is not to create, but again we also should not be complacent in handling this situation. Consult a hematooncologist if you haven't met one yet and discuss about your problems and the aforementioned investigations.

I hope this provides guideline for further investigation. If you have any other concerns, I will be happy to address them.

With regards