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Vertigo, back pain, tiredness, weight loss, palpitations, brain MRI clear, diagnosed as spondyloarthropathy. Is immune system disorder the main reason?

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I am 27 year old guy. I have had symptoms since last 2 years like palpitations, strong heart beat, breath lessness , dizziness, nausea, abdomen pain, sudden blackout, feeling like gonna faint, sweating, extreme weakness in legs and srms. This was just like the symptom of Panic Disorder. Consulted neurophysician ant clear brain MRI. Whenever I have these symptoms, my heartbeat goes upto 105-130 and BP 110-160 (maximum). Consulted a cardiologist, he suggested some blood test, USG abdomen and 2D echocardiogram. Echo was clear except results like Aortic Root=32.4mm (should be less than 22mm) and Left atrium Diameter= 33.1mm (should be less than 22mm). Doctor said Ultrasound is OK and result read- "Mild Hepatomegaly with grade I fatty Liver" and "Liver is mildly enlarged (152.1 mm), "Parenchymal echogenicity is diffusely increased with masking of vascular wall echoes". In blood tests, he found that Vitamin level was very low. It was 126 pg/mL (range 211-911). He said all above symptoms are mainly because of deficiency of vitamin b12 and when I searched on net, found it true that b12 causes this type of symptoms. He prescribed 5 Nurokind Gold (methylcobalamin) injections for alternate days and then once every month. And Nexito 5, A to Z capsules, XXXXXXX 60 K (deficiency of D3 was also there in report). My question is the medicines OK? Secondly Nexito 5 is prescribed as Antidepressant but I don't have any depression or tension. And it is addictive also. Should I take nexito 5 or not. He asked me to take nexito 5 for at least 3 months, once a day. I've read horrible side effects after leaving nexito 5 and it is difficult to come out of the addiction of this medicin. Plz suggest. Doctor also asked me to go for 24 Hr Urine test Catacholamine, Metaniphrine and 5-4I-AA or 5-HI-AA or 5-NI-AA (writing not clear). Please suggest for this also. He said he is asking this to rule out adrenal disorder or tumor.
Symptoms like Panic attack but reason is still unkown. Brain MRI clear. Other tests are being conducted. Got Diagnosed as seronegative spondyloarthropathy and Immune disorder.
Back Pain is also severe if I stand for more than half n hour. Unexpected Weight loss, extreme tiredness, sweating, palpitation and strong heartbeat, back pain after prolonged standing position, sudden blackout together with dizziness/vertigo, breathlessness, fatigue are the symptoms which made me very tense and I am still not sure what specialization should I choose when deciding a doctor. Please suggest. I need help. Is the Immune system disorder the main reason or anything else.
Posted Mon, 18 Jun 2012 in Bones, Muscles and Joints
Answered by Dr. Anil Grover 6 hours later

Thank you for writing in.

From all your writing it looks that you have a multitude of problems. We need more information both in the form of clinical history and investigations to understand your problem better.

1. Seronegative Spondyloarthritis - What all tests were done for this?
2. Immune disorder - You have not written about Anti Nuclear Antibody. Have you got this test done?
3. Aortic root upto 30mm is normal. This is not a concern. Was there any aortic regurgitation detected clinically or on 2D echocardiogram?
4. Panic attacks -The description you gave doesn't seem to be that of panic attacks to me. I understand you may have some amount of anxiety secondary to illness now.
5. Vitamin B12 deficiency can cause some of the symptoms you mentioned and it is good that you are on vitamin b12 supplements. As deficiency of intrinsic factor is the most likely cause, it needs to be ruled out by tests.
6. Fatty Liver - Do you take alcohol?
7. Episodic Hypertension Palpitation - Tests for sympathetic over activity have to be considered. The test suggested to you can give us some idea on this issue.
8. Nexito 5 is an antidepressant. I do not wish to comment on it without understanding your problem better.

To summarize, in view of multi system disease, I would suggest you consult a good Internist.

A medical college will be interested in helping you and Allahabad has one. Best I will suggest is when you can take "take off" for some ten days; go to either SGPGI, Lucknow or AIIMS, New Delhi. XXXXXXX any consultant of XXXXXXX Medicine consultant who can collate all the data.
Alternatively you can upload actual data of investigation on Health Care Magic so that I can guide you about your illness. You can upload the aforementioned details using the feature available on this page.

The symptoms you reported are definitely a cause for concern. But you need not worry. In 2012 there is hardly any illness immune or otherwise which is not treatable.

Hope this helps.

Awaiting your reply.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Vertigo, back pain, tiredness, weight loss, palpitations, brain MRI clear, diagnosed as spondyloarthropathy. Is immune system disorder the main reason? 3 hours later
Dear Sir, Thanks for the prompt response and I appreciate that you have suggested me the right specialization I should go for. I would certainly consult an Internist. Secondly, as per the questions asked by you, I don't take alcohol (fatty liver), and for seronegative spondyloarthropathy, some blood tests were done @ SGPGIMS Lucknow and one of them was HLA B-27. I want to reiterate that I have severe back pain if I stand for more than half and hour and my stamina and fitness has been reduced drastically. Using more than 10 stairs causes me shortness of breath, very strong heart beat and some times blackout together with dizziness and weakness in legs. I am very tensed. Some doctors tell me that it's anxiety or panic disorder but my personal and professional life is smooth and I enjoy life to the fullest (no smoking or alcohol) but these symptoms and back pain since last 3 years made my life hell. Whenever I drive or walk, I fear that I may start feeling dizziness or vertigo and may crash anytime. Which sometimes happens also because of no reason. I, then stop driving instantly or sit if walking. Strong heart beat, weakness of muscles, vertigo are supported by dry mouth. I've lost weight in last 3 months (3 Kgs.) and I always feel weak and sick. Course of Five B12 injections didn't work but I am supposed to take these injections once a month now. And I don't want to take NEXITO 5 as I've read it has strong addiction habit which become worse while trying to leave this drug and secondly I am not depressed so why should I take this antidepressant. And some physicians suggested me to go psychiatrist which I don't understand why. But I still keep Clonazepam tablets (.25 md) with me in case of emergency. Doctor who diagnosed seronegative was HOD neurology in SGPGI and he said my immune system is working against my body which is not curable. What medicines should I take? for back pain or for fatigue/palpitation/strong heartbeat/blackout etc? Don't know where to go.
Answered by Dr. Anil Grover 22 minutes later

Undoubtedly you have a disease which you have been rightly told is Auto Immune: when body's own system attacks itself. I am not being judgmental here but your reaction is to it is slightly exaggerated. You have to think positively: your illness has elements which can be completely cured. There are some elements which you will have to grin and bear. Before, that you ought to have complete picture which a consultant of AIIMS, New Delhi or SPGI, Lucknow can give while talking person to person. You have to be brave and thank the Almighty, for this autoimmune illness is not going to involve brain and you are an intelligent person. So, instead of physical energy you have to maximize the use of mental energy to lead a meaningful life in whatever profession you have chosen. One thing which I could not find answer to in your first question now in the follow up question also I am not sure what is the cause of vertigo. Also, I do not understand your question of not taking a drug because you read somewhere it has addictive potential: that is the question you ought to pose to the prescribing doctor. Lastly, if I were you, and my internist/medical specialist wants me to go to a psychiatrist, I will go- there is no stigma attached to it. It is always helpful in following advice which is given in good faith by the competent physician.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Vertigo, back pain, tiredness, weight loss, palpitations, brain MRI clear, diagnosed as spondyloarthropathy. Is immune system disorder the main reason? 1 hour later
Thanks a lot for this much guidance. I am obliged. Sir, even I am not sure about the reason of vertigo and dizziness. Doctor who prescribed me B12 injection and other drugs told me it might be because of B12 deficiency but exact reason is still a mystry for every doctor I met. Till now I have consulted a cardio, neuro, ortho (back pain) and endocrinologist. Endo asked me to go for 24 hr catacholamine, metaniphrine and 5-HI-AA test. Should I go for it? and as far as psychiatrist is concerned, an online physician on this site suggested me to go to a psychiatrist but no other doctor, whom I met personally, has ever told me to go to psychiatrist. This is the last help required and thanks for your patience.
Answered by Dr. Anil Grover 55 minutes later

Thanks for writing in again. It is always a pleasure e-chatting to an intelligent patient.

1. The cause of vertigo and dizziness is not evident from the data you provided but perhaps physical examination and/or x-rays of spine would have revealed the cause. Therefore, it is better to ask the treating physician regarding this.

2. Vitamin B12 is ordinarily given in oral form; it is given intravenously to you. There may be intrinsic factor deficiency.

I feel that best specialist for you is an internist (who is medical specialist) with specific interest in immunological disorders. Follow his advice about treatment. Naturally, he/she will go through all the previous investigations, spend some time with you and chart out the best management (investigations, consults and treatment) for you.

Have faith in your doctor then, you will much better. I hope this answers all your questions. If you have any further query, I will be very happy to answer.

Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
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