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Dr. Andrew Rynne

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What causes fatigue with dizziness,swollen lymph nodes,blurred vision and headaches?

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Dr. Shruti Rijhwani

Rheumatologist

Practicing since :2008

Answered : 2366 Questions

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Posted on Sat, 16 Aug 2014 in Asthma and Allergy
Question: Hi everyone,
I'd like to get the opinion of an immunologist on what they believe could possibly be causing my health problems.
I've been sick for several years with a 'fatigue syndrome' characterized by fatigue, POTS, dizziness, swollen lymph nodes, blurred vision, headaches and digestive problems. For a long time nothing showed up on test results. Recently I moved to a bigger city and started seeing a Dr. with more experience of this type of problem - he found I have low IgG (5.5-6.5g/L) and IgM (0.2g/L), though the IgG subsets were within normal limits. I also had a FNA of a lymph node which showed reactive lymphadenopathy, which I'm told suggests an infection of some kind.
Also, I was wondering if the following is indicative of any potential problem, my Albumin levels are always on the upper limit of normal (50g/L) while my Alpha-2 Globulin (6g/L), and Gamma Globulin (7g/L) are always on the lower limit. Just wondering if this pattern might suggest some underlying disease process or something.
I have seen an immunologist and have a referral to see another but I just want to get another opinion on where we should possibly focus our search for an underlying cause.

Any input would be very much appreciated, I'm desperate to get some answers and get my life back on track.

Thanks you!
doctor
Answered by Dr. Shruti Rijhwani 3 hours later
Brief Answer:
Follows.

Detailed Answer:
Dear Sir,

Thank you for posting your query on HCM.

Well looking into your problem I would like to tell you that there is a high probabailty of having LUPUS , which can give rise to all these features . Pancreatitis , reactive lymph nodes , fatigue can all be because of that so according to me it should be ruled out at first .

I want to know whether your ANA , ENA profile has been done or not .Plus your complement levels C3 and C4 Reports. You can discuss this with your treating doctor also .

Take care.

Dr. Shruti
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shruti Rijhwani 50 minutes later
Thank so much for your reply Dr. XXXXXXX
I have had my ANA level tested, it came back as less than 80 and has a note saying 'a negative result usually excludes active SLE. Anti-nuclear dsDNA and ENA testing is not warranted unless clinically indicated'. Do you think it is worth getting my ENA profile done?
Could you please elaborate alittle on what complement levels C3 and C4 reports are so I know what to ask my doctor about when I see him. Could you also explain a little about how Lupus is usually diagnosed and what I should look to have done to determine if it is the cause.
Also, are those other results I mentioned (Albumin level etc.) indicative of Lupus or other any other condition?
Another lab result that is slightly abnormal is my anion gap, the result is slightly elevated (13), could you let me know if in your opinion this is indicative of Lupus or any other condition?

Thanks again for your help!
doctor
Answered by Dr. Shruti Rijhwani 12 hours later
Brief Answer:
Follows.

Detailed Answer:
Dear Sir,

Thanks for reverting back.

You had an ANA result of 1:80 by IFA I suppose , which is not negative . A titre of less than 40 is supposed to be negative but it depends on your lab also .

ANA forms one criteria for diagnosing lupus but its not essential ,we do have patients with negative ANA but then the rheumatologist should be able to relate it with clinical features . There are 11 criterias for lupus that involve every system virtually .

Complement levels when low suggest lupus activity although not very specific but can be related.

Plus the most important thing is that you dont have a diagnosis so every testing is worth until we find out something.In my opinion ANA should be repeated along with ENA and anti ds DNA .

But discuss it with your treating doctor as he remains the best judge of your situation. Rest I dont think is much significant . All autoimmune disease are difficult to diagnose and require extensive and repeated testing . Sjogrens syndrome can also be the next possibility after lupus .

Dr. Shruti



Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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