Dr. Ashaq Hussain Parrey
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
Medically reviewed by
Patient's Query
Hello doctor,
I am writing about my wife. She is a 34-year-old female. Roughly about six weeks ago, she started feeling terrible. She had a run down, fevers, night sweats, and trouble regulating her body temperature. However, she had no flu-like symptoms. She went to the doctor, who ran blood work showing very elevated LFTs and lymphocytes. She was referred for an ultrasound of the liver showed a mildly enlarged spleen, a mildly fatty liver, and a very large gallstone. Fast forward to now, she is feeling a lot better, with the exception that she still overheats, meaning that she starts to sweat a lot easier than she was previously from minimal activity. She has a prominent lymph node on her right neck, so the doctor reran blood work. Bloodwork all returned to normal. I think absolute lymphocytes were slightly above normal but much lower than originally. However, she was referred for an ultrasound, which had some scary findings (attached). And the most scary part is, she has lost about ten pounds in the last month without trying. The doctor also ran some additional bloodwork, which showed abnormal ANA that was speckled. Any thoughts here?
Hello,
Welcome to iclinic.com.
I understand your concern.
I went through your post. Firstly, a single lymph node is very rarely lymphoma. The symptoms of lymphoma will not improve without treatment of lymphoma. So, the chances are very low. Secondly, ANA (antinuclear antibody) positive is seen in 10 % of the general population and isolated positive ANA without symptoms of connective tissue diseases carry little significance. ANA is induced by both viral and bacterial infections. What you will need to do is an ENA (extractable nuclear antigen) profile to rule out connective tissue disorder. Secondly, your US (ultrasound) report is not available on chat I could not see it uploaded.
Hope this helps.
Regards.
Patient's Query
Hello doctor,
Thanks. It is the symptoms, particularly the weight loss, that have me most concerned. Her US and CT also showed multiple swollen lymph nodes.
Hi,
Welcome back to icliniq.com.
Please update the reports through mail. Yes, unintentional weight loss of more than 10 % of body weight is always abnormal and needs to be investigated. However, any infection, especially chronic, can lead to it. Send all the blood work and report to the doctor as soon as possible.
Hope this helps.
Kind regards.
Patient's Query
Hello doctor,
Thanks.
Should I email it?
Hi,
Welcome back to icliniq.com.
Yes, please send an email.
Regards.
Patient's Query
Hi doctor,
Thanks. What email address do I use?
Hi,
Welcome back to icliniq.com.
This is the email address, icliniq@icliniq.com.
Regards.
Patient's Query
Hi doctor,
Thanks. Yes, I have sent.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Let me see. I saw your reports (attachments are hidden to protect the patient's identity). If you have multiple cervical lymph nodes, a few more than 1 cm, you need to take one week of antibiotics Amoxclav (Amoxycillin and Clavulanic acid). If they do not regress, get FNAC (fine needle aspiration cytology) of the node done and an ESR (erythrocyte sedimentation rate).
Hope this helps.
Kind regards.
Patient's Query
Hi doctor,
Thanks again.
What is an ESR? I have just sent some more results. One of them was the sedimentation rate.
Hi,
Welcome back to icliniq.com.
How much is the sedimentation rate? I have not received it yet. ESR is the sedimentation rate.
Hope this helps.
Kind regards.
Patient's Query
Hi doctor,
Thanks.
It is 10 mm.
Hi,
Welcome back to icliniq.com.
I understand your concern.
That is normal. What about LDH?
Revert with answers.
Kind regards.
Patient's Query
Hi doctor,
Thanks again.
I did not see that on her most recent results. The only abnormal thing was ANA. Would that be part of a CBC?
Hi,
Welcome back to icliniq.com.
That is generally part of serum chemistry.
Hope this helps.
Kind regards.
Patient's Query
Hello doctor,
Thanks again. Got it. I am not sure it was ordered then. The sedimentation rate is a positive sign that it may not be cancer, right?
Hi,
Welcome back to icliniq.com.
It generally means that nodes are not tuberculosis or lupus-associated, and yes, to some extent, it is not cancerous.
Hope this addresses your concern.
Thanks.
Patient's Query
Hi doctor,
Thanks for the reply.
What about the fact that her lymphocytes were high but then came back down? Is there anything to that?
Hi,
Welcome back to icliniq.com.
I understand your query.
Yes, in acute viral infection, lymphocytes increase. Once the infection resolves, the count comes down.
Hope this answers your query.
Regards.
Patient's Query
Hi doctor,
Thank you. But would not you expect node size to reduce as lymphocytes came down?
Hi,
Welcome back to icliniq.com.
I understand your concern.
Yes, but sometimes nodes can stay for up to nine months.
Hope this helps.
Kind regards.
Patient's Query
Hello doctor,
Thanks.
Can a virus manifest without true cold-like symptoms, though? I find everything about these results to be confusing. Nothing seems to add up perfectly.
Hi,
Welcome back to icliniq.com.
I understand your query and concern.
Some viruses do, but as I said in my first post, ENA profile, LDH (lactate dehydrogenase), and FNAC would be enough to come to a final conclusion.
Hope this addresses your concern.
Thanks.
Patient's Query
Hello doctor,
Thanks.
What do you think it is, most likely based on what you have seen to date?
Hi,
Welcome back to icliniq.com.
I understand your concern.
I believe it is due to viral infection, but before that, I will investigate the node to confirm because every disease is curable if diagnosed early.
Hope this helps.
Regards.
Was this conversation helpful?
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