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Pain and swelling in left temple and febrile, left eye is blurry. What could it be?

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General & Family Physician
Practicing since : 2007
Answered : 301 Questions
I am a 35 year old Caucasian female. Starting on 10/17/13, I began to be febrile (low grade) and had achy joints. On 10/18/13, I visited the local urgent care with pain and swelling in my left temple and febrile. MD thought I my have something viral going on and advised me to monitor at home. On 10/19/13, the left side of my face became very swollen and the vision in my left eye was blurry. I visited urgent care again, a sed rate and sinus films were performed and found to be normal. The MD considered maybe temporal arteritis, cellulitis, and maybe even shingles. Prescribed a course of cephalexin. On 10/21/13, I saw my PCP with worsening of symptoms. She performed a CBC, sed rate, and CRP and all were normal. She thought this may be temporal arteritis or shingles. She treated with Valtrex 1000mg TID, continue cephalexin, and added Prednisone on a tapering course for 9 days (40mg, 20mg, 10mg). I felt dramatically better 24 hours after starting the prednisone. She also referred me to an ENT on 10/21/13. The ENT was not sure what was going on, but felt confident that this was not temporal arteritis due to the location of the swelling. He advised me to follow the course of medications as directed and to recheck with an Ophthalmologist for my vision in my left eye and to return to him on 10/25/13. I saw the Ophthalmologist on 10/22/13 and my vision was found to be WNL. The Ophthalmologist thought that the vision distortion was due to soft tissue swelling around my eye and not due to an actual eye problem. The vision distortion cleared with the swelling decreasing. On 10/25/13, I rechecked with the ENT at which time he noted a small mass (few cm) in my left temporal area. He advised me to continue medications and to recheck the following week. On 10/27/13, the swelling in my left temple returned (on 10mg pred at this time) and I rechecked with the ENT on 10/28/13 as a result. On 10/28/13, the ENT informed me that he would like to image the mass and obtain a FNA of the mass. He changed my abics to doxycycline and increased my prednisone again. The prednisone has not helped at all this time. An ultrasound was performed by a radiologist on 10/29/13 and he reported that the mass appears to be an edematous lymph node. I will be having the FNA performed this afternoon. I called the ENT on 10/29/13 to report that I now have a painful swelling in my left arm in the antecubital region. I am still intermittently febrile and I am exhausted. No one seems to have any ideas about what might be causing these problems at this time.
For history reference: I am a veterinary technician and work with dogs and cats daily. I have traveled to Ohio and Michigan within the past several months. My medical history includes asthma, allergies (seasonal), chronic UTIs and a history of HSV-2.
Posted Tue, 19 Nov 2013 in Medicines and Side Effects
Answered by Dr. David Okia 1 hour later
Brief Answer:
Infected lymph node, Intravenous antibiotics

Detailed Answer:

Thanks for your question.

Based on your history above and my experience you most likely have an infected lymph node.

I usually do culture and sensitivity so that I can know which microbes are causing the infection in lymph node.

As you wait for FNA I would recommend you start on intravenous antibiotics ceftriaxone one gram once day for 3 days plus tabs azithromycin and pain killer like paracetamol. My patients with similar complains do well on these antibiotics.

You can continue with prednisolone as prescribed. I would also recommend other virological tests, random blood sugar and blood pressure to be checked.

Hope I answered your question, will be happy to help you if you have other queries.

Wishing you speedy recovery.

Above answer was peer-reviewed by
Follow-up: Pain and swelling in left temple and febrile, left eye is blurry. What could it be? 7 hours later
My FNA results came back inconclusive. The pathologist said that the LN is not neoplastic and it is also not reactive. My blood pressure is normal. My BG is normal at 74mg/dl. I recheck with the ENT tomorrow. The pathologist said that I might benefit from infectious disease testing.
Answered by Dr. David Okia 6 hours later
Brief Answer:
The above antibiotics will help you

Detailed Answer:
Hi and thanks for follow up results.
I would recommend you start on injection ceftriaxone and tablet azithromycin. This has helped many of my patients with similar conditions.
Above answer was peer-reviewed by
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