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What Causes Severe Back Pain, Fatigue And Memory Lapse When Recovering From Infection?
Question: Hi,
I'm a 23-year old European male. After a respiratory tract infection in January 2014 treated with ATB I started suffering from brain fog, severe fatigue, memory lapses, concentration problems, coordination difficulties, reading difficulty (eye movement problems) and urinary dribbling, accompanied with severe back pain. Most of the symptoms have lasted until now in similar or slightly lower severity.
I saw many specialists, including internal medicine, cardiology, neurology, physiotherapy and others. MRIs of brain and spinal cord came negative of anything.
The only things that were abnormal were:
blood - elevated IgE 279... range: 0-100 IU/ml
low ACE
spinal tap - systemic inflammatory response; but no signs of neuroinfection --> secondarily induced inflammation; increased BBB permeability, low C4; positive anti CMV and anti VZV; traces of neuro-destruction
MRI of spine - spinal instability, inflammatory spondylitic changes
EEG - mixed episodic theta-delta slow-down
Cognitive testing - concentration and memory deficiency
Urology - hyperactive hypersensitive detrusor, dyscoordinated sphincter
So it seems that I have some sort of ongoing inflammation that did not arise in the brain but somewhere else in the body and then got into the brain through a weakened BBB.
I have two questions for you.
1) Given the elevated IgE, do you think that some form of parasitic infection / systemic candidiasis should be considered? I was suggested that through a second-opinion doctor but he's not sure as he's not an immunologist. I don't seem to have the common symptoms of a parasitic infection except for quite frequent bowel emptying.
2) What would be your suggestion of a diagnosis? My doctor suggested Acute demyelinating encephalo-myelitis for which there is, however, only a little proof in the liquor.
Thank you!
All the best,
XXXX
I'm a 23-year old European male. After a respiratory tract infection in January 2014 treated with ATB I started suffering from brain fog, severe fatigue, memory lapses, concentration problems, coordination difficulties, reading difficulty (eye movement problems) and urinary dribbling, accompanied with severe back pain. Most of the symptoms have lasted until now in similar or slightly lower severity.
I saw many specialists, including internal medicine, cardiology, neurology, physiotherapy and others. MRIs of brain and spinal cord came negative of anything.
The only things that were abnormal were:
blood - elevated IgE 279... range: 0-100 IU/ml
low ACE
spinal tap - systemic inflammatory response; but no signs of neuroinfection --> secondarily induced inflammation; increased BBB permeability, low C4; positive anti CMV and anti VZV; traces of neuro-destruction
MRI of spine - spinal instability, inflammatory spondylitic changes
EEG - mixed episodic theta-delta slow-down
Cognitive testing - concentration and memory deficiency
Urology - hyperactive hypersensitive detrusor, dyscoordinated sphincter
So it seems that I have some sort of ongoing inflammation that did not arise in the brain but somewhere else in the body and then got into the brain through a weakened BBB.
I have two questions for you.
1) Given the elevated IgE, do you think that some form of parasitic infection / systemic candidiasis should be considered? I was suggested that through a second-opinion doctor but he's not sure as he's not an immunologist. I don't seem to have the common symptoms of a parasitic infection except for quite frequent bowel emptying.
2) What would be your suggestion of a diagnosis? My doctor suggested Acute demyelinating encephalo-myelitis for which there is, however, only a little proof in the liquor.
Thank you!
All the best,
XXXX
Brief Answer:
Post viral syndrome.
Detailed Answer:
Hi,
Thank you for your query.
1. What you are experiencing is a post viral syndrome.
2. After going through your previous questions and answers if would like to add the following:
3. These syndromes may last for months or years and may resolve in time or relapse.
4. There is a psychological overlay and hence it is better to try out treatment.
5. Various medications can be tried, including anti-parasite, anti-fungal, steroids and so on. However there is no established curative medication.
6. Get a VNG (VideoNystagmoGraphy), VHIT (Video Head Impulse Test) and Subjective Visual Vertical testing done. Upload the results here.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Post viral syndrome.
Detailed Answer:
Hi,
Thank you for your query.
1. What you are experiencing is a post viral syndrome.
2. After going through your previous questions and answers if would like to add the following:
3. These syndromes may last for months or years and may resolve in time or relapse.
4. There is a psychological overlay and hence it is better to try out treatment.
5. Various medications can be tried, including anti-parasite, anti-fungal, steroids and so on. However there is no established curative medication.
6. Get a VNG (VideoNystagmoGraphy), VHIT (Video Head Impulse Test) and Subjective Visual Vertical testing done. Upload the results here.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your answer.
Which medical specialisation offers these tests? I'm seeing a neuroophtalmologist in a week. Would that be it?
I'm not really sure either what's the added benefit of those tests that you suggested.
Is there any point in trying anti-parasite or anti-fungal medication? I mean, shouldn't some testing be done to determine whether there is such a problem in the first place? what's the chance that the elevated IgE is due to a parasite infection rather than just atopy?
There seems to be inflammation in my body but I'm not convinced that there's some sort of global infection happening...
Which medical specialisation offers these tests? I'm seeing a neuroophtalmologist in a week. Would that be it?
I'm not really sure either what's the added benefit of those tests that you suggested.
Is there any point in trying anti-parasite or anti-fungal medication? I mean, shouldn't some testing be done to determine whether there is such a problem in the first place? what's the chance that the elevated IgE is due to a parasite infection rather than just atopy?
There seems to be inflammation in my body but I'm not convinced that there's some sort of global infection happening...
Brief Answer:
Neurotologist.
Detailed Answer:
Hi,
Thank you for writing back.
1. A Neurotologist will be able to perform these tests.
2. These tests are important because they quantify any existing problem.
3. It is important to rule out atopy or allergy by multiple tests on the blood and skin prick tests. An allergist will be able to do this.
4. You can test for parasites and fungal infections. However it is easier to take a course of medication to speed things up.
5. You need to narrow down the possible causes. It is also important to remember that the cause of the raised IgE may not be determined.
6. Many inflammatory markers may be raised. Get your ESR, C-RP and autoimmune work-up done.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Neurotologist.
Detailed Answer:
Hi,
Thank you for writing back.
1. A Neurotologist will be able to perform these tests.
2. These tests are important because they quantify any existing problem.
3. It is important to rule out atopy or allergy by multiple tests on the blood and skin prick tests. An allergist will be able to do this.
4. You can test for parasites and fungal infections. However it is easier to take a course of medication to speed things up.
5. You need to narrow down the possible causes. It is also important to remember that the cause of the raised IgE may not be determined.
6. Many inflammatory markers may be raised. Get your ESR, C-RP and autoimmune work-up done.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks. Now my understanding is better.
My mother has atopy so if atopy is shown then that rules out parasites, right?
What anti-parasitic/anti-fungal medication would you prescribe to a patient like me who came to your office?
Thanks.
XXXX
My mother has atopy so if atopy is shown then that rules out parasites, right?
What anti-parasitic/anti-fungal medication would you prescribe to a patient like me who came to your office?
Thanks.
XXXX
Brief Answer:
Both parasitosis and atopy may co-exist.
Detailed Answer:
Hi,
Thank you for your query.
1. Parasite infestation is very common worldwide and may co-exist with atopy. Hence the need for tests to check for atopy.
2. The most commonly used medications for gut parasites is albendazole 400mg single dose and for fungal infections, fluconazole 150 or itraconazole 400 for a week. Remember that anti-fungal medications have many drug interactions and hence take such medication only under the strict supervision of a doctor.
3. To increase the accuracy, blood, stool samples, scrapings, swabs may be tested.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Both parasitosis and atopy may co-exist.
Detailed Answer:
Hi,
Thank you for your query.
1. Parasite infestation is very common worldwide and may co-exist with atopy. Hence the need for tests to check for atopy.
2. The most commonly used medications for gut parasites is albendazole 400mg single dose and for fungal infections, fluconazole 150 or itraconazole 400 for a week. Remember that anti-fungal medications have many drug interactions and hence take such medication only under the strict supervision of a doctor.
3. To increase the accuracy, blood, stool samples, scrapings, swabs may be tested.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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