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Suggest Treatment For Severe Fatigue, Muscle And Knee Pain
Question: 33 yr old female with a 6 month history of severe fatigue (sleeping 12+ hours with minimal relief) memory/concentration impairment,
Enlarged cervical, occipital, and sub mental lymph nodes.. Non painful, muscle pain and weakness , joint pain without swelling or redness.. Primarily hips knees and feet and painful raised facial lesions that occasionally will have clear to bloody drainage. Cystic acne has been ruled out by two physicians but they are unable to diagnose my condition as all of these symptoms suddenly began within a few weeks of each other. Recently had blood work (8/10/16) and I have compared it to the last results which were on (5/1/16) just looking for answers bc I've recently had to stop working due to the above symptoms. Any Advice would be wonderful
WBC: 4.7 .. Now 8.3
HgB: 11.. " 12.5
Hct: 33.9... 37
RBC: 3.3 ... 4.12
Mcv, mch, mchc, rdw : wnl
Platlets: 217.. Now 241
Vit D 22 (now taking 50,000 iuweekly)
Lymph 43% now 17%
Neutrophils 50% now 74%
Cardio hs- CRP: 7.6
AST and ALT: 17
ANA Antibody- negative
RA FACTOR- <10
TSH 1.3
Thyroid Peroxidase antibody <28
Additional info:
Current meds- adderall lexapro and vitamin d 50000 weekly
Past treatment for the above symptoms - NSAIDs, doxy, Bactrim, augmentin, levaquin, clindamycin, augmentin
Past surgeries- 2009 tonsillectomy, 2006/2012 breast augmentation (silicone) -breast MRI scheduled today to check for possible leak/rupture of implant
Family hx - strong fam hx of cardiac disease and Hodgkin's lymphoma
Enlarged cervical, occipital, and sub mental lymph nodes.. Non painful, muscle pain and weakness , joint pain without swelling or redness.. Primarily hips knees and feet and painful raised facial lesions that occasionally will have clear to bloody drainage. Cystic acne has been ruled out by two physicians but they are unable to diagnose my condition as all of these symptoms suddenly began within a few weeks of each other. Recently had blood work (8/10/16) and I have compared it to the last results which were on (5/1/16) just looking for answers bc I've recently had to stop working due to the above symptoms. Any Advice would be wonderful
WBC: 4.7 .. Now 8.3
HgB: 11.. " 12.5
Hct: 33.9... 37
RBC: 3.3 ... 4.12
Mcv, mch, mchc, rdw : wnl
Platlets: 217.. Now 241
Vit D 22 (now taking 50,000 iuweekly)
Lymph 43% now 17%
Neutrophils 50% now 74%
Cardio hs- CRP: 7.6
AST and ALT: 17
ANA Antibody- negative
RA FACTOR- <10
TSH 1.3
Thyroid Peroxidase antibody <28
Additional info:
Current meds- adderall lexapro and vitamin d 50000 weekly
Past treatment for the above symptoms - NSAIDs, doxy, Bactrim, augmentin, levaquin, clindamycin, augmentin
Past surgeries- 2009 tonsillectomy, 2006/2012 breast augmentation (silicone) -breast MRI scheduled today to check for possible leak/rupture of implant
Family hx - strong fam hx of cardiac disease and Hodgkin's lymphoma
Brief Answer:
complicated situation
Detailed Answer:
Hello and thank you for your clinical history.
I have read your history and looked at your lab values. This clinical picture does not present an obvious picture to me so I think that further testing is going to be necessary. I will make suggestions based on symptoms.
Fatigue
If you are overweight and/or snore then getting a sleep study to rule out sleep apnea would be a good idea.
If you drink any alcohol or caffeine I suggest that you discontinue that use.
I would add a multivitamin to your daily regimen.
I would add a probiotic at least twice a day since you have surely gotten rid of all your useful gut bacterial with all the antibiotics you have taken.
Skin lesions
I suggest that you see a dermatologist for a biopsy of these skin lesions to see if they can find the cause.
Lymph nodes
anterior nodes are often from a head and neck infection, if ear, sinus and throat infection have all bee ruled out then I suggest a node biopsy to get an idea of the cause.
A few other thoughts
Since these symptoms tend to be systemic a chest xray may be helpful especially if you have cough or any other respiratory symptoms
Testing for syphilis, lyme, histoplasmosis or rocky mountain spotted fever may be a good idea if you are at risk for any of these (your local doctor can best determine this)
I hope you find an answer soon and thanks for using HCM
Dr. Robinson
complicated situation
Detailed Answer:
Hello and thank you for your clinical history.
I have read your history and looked at your lab values. This clinical picture does not present an obvious picture to me so I think that further testing is going to be necessary. I will make suggestions based on symptoms.
Fatigue
If you are overweight and/or snore then getting a sleep study to rule out sleep apnea would be a good idea.
If you drink any alcohol or caffeine I suggest that you discontinue that use.
I would add a multivitamin to your daily regimen.
I would add a probiotic at least twice a day since you have surely gotten rid of all your useful gut bacterial with all the antibiotics you have taken.
Skin lesions
I suggest that you see a dermatologist for a biopsy of these skin lesions to see if they can find the cause.
Lymph nodes
anterior nodes are often from a head and neck infection, if ear, sinus and throat infection have all bee ruled out then I suggest a node biopsy to get an idea of the cause.
A few other thoughts
Since these symptoms tend to be systemic a chest xray may be helpful especially if you have cough or any other respiratory symptoms
Testing for syphilis, lyme, histoplasmosis or rocky mountain spotted fever may be a good idea if you are at risk for any of these (your local doctor can best determine this)
I hope you find an answer soon and thanks for using HCM
Dr. Robinson
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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