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Dr. Andrew Rynne

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Exp 50 years

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Dr. Antoneta Zotaj

General & Family Physician

Practicing since :2004

Answered : 1747 Questions

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Posted on Wed, 9 Jan 2019 in General Health
Question: Welcome o 'Ask a Doctor'. Please type your question here...
High monocytes at 12% and eosinophils high @ 5% severe pain in feet that came on very suddenly August 28, 2018. Pain has moved to my ankles (also swollen) and some pain in my toes. Weight loss, dehydrated, strong urine smell and darkish color at times. Very painful walking. Night sweats and itchy rash on torso and neck. On percocet, barely touches pain. Have done MRI and CT of upper spine and head that was normal. Did chest X-ray and feet x Ray, also normal
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Follow up: Dr. Antoneta Zotaj 5 minutes later
I thought I got answer now
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Answered by Dr. Antoneta Zotaj 14 minutes later
Brief Answer:
Kindly asked to give some more information related to the condition

Detailed Answer:
Hello,

I carefully read your question and would like to know few more information related to your condition.

Kindly asked to answer the following questions:
- did the pain start at the sole of the foot or on the upper part of the foot?
- do you have swelling only on the ankles or the rest of the foot as well?
- do you have local heat feeling and redness as well?
- do your feet feel stiff as well, worse in the morning and longer then 30 minutes?
- have you had similar problems with joints before?
- any problems with other joints?
- Other then the blood test mentioned and the xray and MRI and CT examination have you had other blood tests, for example tests for autoimmune disease like rheumatoid arthritis, etc, or urinalysis? Can you attach the results?
- can you explain a little more on the rash, for how long has it been there?
- can you attach a picture of the rash so i can have a better understanding how it looks?
- any fever? Or mouth ulcers?
- have you suffered before with any kind of infections?
- any one at home having similar problems?

Joint pains and skin rash when happening together may be caused from different disease ranging from infectious causes to autoimmune conditions and a good history and sometimes extended blood tests might be needed to identify the exact cause.

Please let me know of the above questions so I can better evaluate your condition.

I am waiting for your reply.

Kind regards,

Antoneta Zotaj
General and Family Physician
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Antoneta Zotaj 32 minutes later
Pain started in right toe. Thought it was gout. After bood test Dr said it was not. Pain went into both feet about 1 week after 1st symptom in toe. Swelling in feet that gradually moved to extreme pain in both ankles. Warm to the rouch. Pain has never gone away from day 1. My feet feel better “I think” in morning, hard to tell because it’s an all the time pain. Had tests for autoimmune with negative results. Said in X-ray no signs of rheumatoid arthritis. Haven’t had joint problems before. The rash came on about a week ago on back, stomach and necks. Little bumps that itched. They all turned to small scabs and are pretty much gone. I did have problems with mouth ulcers for the first 2-3 months but have subsided a little. No others in home are having problems. And really no other infections except early this year had bronchitis. My mom died 3 years ago with autoimmune disease. Died from sciroccos of liver. Never drank alcohol. She also had radiation treatments for multiple myeloma
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Follow up: Dr. Antoneta Zotaj 1 minute later
Also have low MCHC @ 31.2%
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Answered by Dr. Antoneta Zotaj 6 minutes later
Brief Answer:
Detailed answer below

Detailed Answer:
Hello,

Thank you for the detailed answers. Do you know for which autoimmune conditions you have been checked. It is rheumatoid arthritis, psoriasis, sarcoidosis, and systemic lupus that can cause both joint inflammation and skin rash.
Because your mother has had autoimmune disease and because the joints at your feet have signs of inflammation (swollen and hot) this is the first to rule out. Rheumatoid arthritis might not cause changes in the xray of the joints in the beginning so follow up with xrays might be good to see if there are changes in time.

How is you ERS? Can you attach the blood test results (for the autoimmune conditions and CBC with ERS- the uploaded test results are only the differential of the white blood cells) you had and urinalysis? A picture of the rash would be helpful as well.

Infectious conditions like lyme disease, syphilis, etc, might cause as well joint problems and skin rash, even though in your case I think they are less likely, still it is worth doing tests to rule them out.

You might need to talk with the doctor on detail on the possible diagnosis and which ones he thinks he has ruled out and how and if there is other tests needed to be done to make sure immune conditions are well covered.

I hope I have answered to your question but please let me know if i can assist you further.

Kind regards,

Antoneta Zotaj,
General and Family physician



Above answer was peer-reviewed by : Dr. Remy Koshy
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