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What causes rapid weight loss, persistent fever, diarrhea and low WBC level?

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Posted on Mon, 23 May 2016
Question: I have a purple rah on my lower leg above my ankle. I have been having night sweats, fever and lost 15 pounds in the last 4 months without trying and feel full after eating a small amount of food. Also, I have trouble swallowing, pain in my chest and underneath my arm on my left side. I'm always tired and can't sleep enough to make me feel rested, plus getting tired and flushed after small tasks.
The purple rash I've had has been since May, and I have had diarrhea for over a year, almost every day.
I went to my family practitioner and he ordered blood tests which revealed I have a low 2.9 wbc and a high 25 sedimentation rate. What is going on with me? My doctor retired the same week in went in so I'm in the dark about what he's looking for?
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Answered by Dr. Saddiq Ulabidin (2 hours later)
Brief Answer:
Needs detailed evaluation with vasculitis profile and baseline labs

Detailed Answer:
Hi! Welcome to health care magic!
I have read you query and understand your concern.

Based on the history you have shared, most alarming signs I would grade are 15 pounds weight loss, swallowing difficulty and long standing fever with night sweats. These along with chronic diarrhea of such long duration and rash with lethargic feelings need to have detailed lab investigations.
Complete blood picture and ESR are not just enough, and there is urgent need of more detailed evaluation. To start with, for swallowing difficulty with weight loss, repeat the complete blood picture and have ultrasound abdomen and plan for oesophagoduodenoscopy which is few minutes procedure but is mandatory keeping in view your detailed symptoms. Meanwhile keep strict charting of weight with one weighing scales and follow it monthly for severity of any ongoing weight loss.

For chronic diarrhea, as well for difficulty swallowing a detailed meeting with a gastroentrologist would be a good strategy and plan the work up according to his advice. Mostly chronic diarrhea leads to decreased absorption of essential micronutrients or malabsorption syndrome which can lead to symptoms of lethargy etc. For that you can continue the supplements of B12, D3, and folic acid.
Gastroentrologist may ask for a colonoscopy sooner or later so remain in follow up with him regarding that.

For rash, with fever and night sweats first approach would be to get autoimmune and vasculitis profile done. For such long standing fever, follow up ESR and CRP may be needed along with detailed evaluation for lymph nodes. Meanwhile make a fever chart so that your physician gets help with that. Blood cultures may also be needed.

Lastly I would again suggest to have detailed review by your doctor as treatment delay is never a good approach and that is only possible after appropriate diagnosis which is only possible after detailed follow up and evaluation. Meanwhile keep using OTC analgesics like acetaminophen for fever and pains.

Hope this has answered your query, if you have any more questions, feel free to ask. Regards.



Above answer was peer-reviewed by : Dr. Deepak
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Answered by
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Dr. Saddiq Ulabidin

General & Family Physician

Practicing since :2011

Answered : 3941 Questions

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What causes rapid weight loss, persistent fever, diarrhea and low WBC level?

Brief Answer: Needs detailed evaluation with vasculitis profile and baseline labs Detailed Answer: Hi! Welcome to health care magic! I have read you query and understand your concern. Based on the history you have shared, most alarming signs I would grade are 15 pounds weight loss, swallowing difficulty and long standing fever with night sweats. These along with chronic diarrhea of such long duration and rash with lethargic feelings need to have detailed lab investigations. Complete blood picture and ESR are not just enough, and there is urgent need of more detailed evaluation. To start with, for swallowing difficulty with weight loss, repeat the complete blood picture and have ultrasound abdomen and plan for oesophagoduodenoscopy which is few minutes procedure but is mandatory keeping in view your detailed symptoms. Meanwhile keep strict charting of weight with one weighing scales and follow it monthly for severity of any ongoing weight loss. For chronic diarrhea, as well for difficulty swallowing a detailed meeting with a gastroentrologist would be a good strategy and plan the work up according to his advice. Mostly chronic diarrhea leads to decreased absorption of essential micronutrients or malabsorption syndrome which can lead to symptoms of lethargy etc. For that you can continue the supplements of B12, D3, and folic acid. Gastroentrologist may ask for a colonoscopy sooner or later so remain in follow up with him regarding that. For rash, with fever and night sweats first approach would be to get autoimmune and vasculitis profile done. For such long standing fever, follow up ESR and CRP may be needed along with detailed evaluation for lymph nodes. Meanwhile make a fever chart so that your physician gets help with that. Blood cultures may also be needed. Lastly I would again suggest to have detailed review by your doctor as treatment delay is never a good approach and that is only possible after appropriate diagnosis which is only possible after detailed follow up and evaluation. Meanwhile keep using OTC analgesics like acetaminophen for fever and pains. Hope this has answered your query, if you have any more questions, feel free to ask. Regards.