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Suggest Treatment For Cough, Rash And Headaches

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Posted on Mon, 27 Apr 2015
Question: Hi I have pin prick rash I also have a temp headache and glands is up more at one side of neck I have a cough and have now been priscribed steroids I also have small courless spots on the roof of my mouth . The crash started on Wed and the other symptoms at start of week . I have a young daughter who is 2 and she has had a bad cough for weeks . She takes home a lot of viruses bacterial infection s . Because my immune system Is weak I seem to be catching one thing after another. I took a relapse back in Dec last year and never recovered properly leaving left side weakness and tremor fatigue . When I get a viruses or bacteria it makes the underlying condition worse also . Fatigue mobility tremor balance all increase . Yesterday I was feeling very confused I couldn't verbalize what I wanted to say . I found this very distressing . I'm worried Bout the rash as I don't tend to get many rashes .
doctor
Answered by Dr. Sudhir Kumar (1 hour later)
Brief Answer:
Need to confirm the diagnosis.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your symptoms and seen the images.

I agree that these rashes are part of autoimmune diseases, as skin and mucous membrane involvement is common with auto-immune diseases. However, we need to confirm the diagnosis. This would require doing additional tests such as ANA profile, anti dsDNA, serum complement, rheumatoid factor, etc. A biopsy of the skin lesion may also be needed to exclude vasculitis.

At present, it may be better to use high dose steroids, such as methylprednisolone injections for three days.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sudhir Kumar (18 minutes later)
Hi there rheumatoid as been ruled out I have done all Ana and ra etc . Only thing left could be is ms or vasculitis does it look like a vasculitis rash ? I can't get any help for my condition here . They only prescribed me 30mg of oral steroid . As my breathing is also affected and my throat feels quite closed . My first attack was at 13 years old paralysed arm lasted about a day dr said migraine so mother accepted and trusted the doctor . Just under 2 years later another attack that put me in ambulance my speech non coherent my vision went grey with squares . Vertigo .i was walking into doors and walls and vomiting . I got left no scans nothing they told me confusing migraine and said clinically isolated event this was recorded on my notes . Nothing was done .I accepted the doctor s diagnoses and continued to have attacks at home I would get about 2 a year's sometimes I had facial pain it was so bad I couldn't do anything but scream and put ice on it . Because it only lasted a day or so I just went on with my life . Then I had other attacks similar numbness in face and other time tingling etc these attacks I could not do anything but lay in bed thinking I was going to die . Because they were short lived I didn't go back to doctor . I then went to my gp with tremor and back pain fatigue age 18 this was the start of the illness .now I get relapses flares that last about 6 weeks but they affect me pain memory stiffness tremor balance blurry vision . I can't go out when I get these. It takes me a long time to recover I feel I'm getting worse not bouncing back the same as I used to I have more mobility issues . I believe they have not caught my diagnoses at a young age and I'm suffering terribly now . It started age 13 I'm now 35 over the years I have had spells where I feel better then it comes back again . Could you give me your opinion please I dint want to suffer any longer without medication I feel I require ..kind regards XXXXXXX

I have had a Mri done of spine and brain but without contrast in 2008 I did have t2 hperintense lesions they said non specific what does this mean ? I also had evoke potentials and I had a slow nerve from brain to leg again they give me no explanation. I have suffered terribly with this illness for over 20 years without medical help . I get great pain and discomfort . I don't have much of a life I spend most my time at home as when the fatigue hits usually around 2 pm is debilitating . The fatigue can happen at any time though . While in flare relapse it's there constantly . Because this is over 20 years I have lived with it.
doctor
Answered by Dr. Sudhir Kumar (10 hours later)
Brief Answer:
Vasculitis and MS are more likely.

Detailed Answer:
Thank you for getting back and providing more information. It is unfortunate that you are suffering for more than two decades.

I agree that rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been excluded by appropriate blood tests.

At this stage, we need to consider multiple sclerosis (MS) and vasculitis. The MRI abnormalities and evoked potential abnormalities could fit in with a diagnosis of MS. For further confirmation of MS, lumbar puncture with oligoclonal bands and repeat MRI of brain and spine may be done. If confirmed, interferon injections or one of the newer oral drugs such as fingolimod or dimethylfumarate can give you a much better quality of life, by preventing further relapses.

In view of skin lesions and rashes, we also need to consider vasculitis. In you case, doing a skin biopsy is the simplest method to prove or exclude vasculitis.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar (6 hours later)
Hi Dr thank you for your information. I have had a lumbar puncture dine but this wasn't till 2008 and my first symptoms was 1993 . This was negative no bands . Can this result change in time. Also wouldnt it make sense for my neurologist to give me a second scan to see if there dissemination time and space ?do I have to have the bands to have ms ?
doctor
Answered by Dr. Sudhir Kumar (5 hours later)
Brief Answer:
MRI should be repeated.

Detailed Answer:
Thank you for getting back.

Yes, I agree that MRI of brain and spine should be repeated to look for any new lesions.

Also, oligoclonal bands in CSF are not mandatory for a diagnosis of MS. Oligoclonal bands may change in time, they would be present when the disease is active or during a relapse.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sudhir Kumar

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Suggest Treatment For Cough, Rash And Headaches

Brief Answer: Need to confirm the diagnosis. Detailed Answer: Hi, Thank you for posting your query. I have noted your symptoms and seen the images. I agree that these rashes are part of autoimmune diseases, as skin and mucous membrane involvement is common with auto-immune diseases. However, we need to confirm the diagnosis. This would require doing additional tests such as ANA profile, anti dsDNA, serum complement, rheumatoid factor, etc. A biopsy of the skin lesion may also be needed to exclude vasculitis. At present, it may be better to use high dose steroids, such as methylprednisolone injections for three days. I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, XXXXXXX XXXXXXX Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in