Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had unprotected sexual exposure around four months ago, and after that, I found a swelling in my right scrotum (after scanning found benign) consulted a urologist and told him about my exposure, and he prescribed Azhithral injections, but I was unable to take as it became allergic in the test dose and then he gave me Doxy LDR1 forte (14 no.s) and Flavospas 200 mg for one week. When I was consuming this, I got heavy pain in my body, and after some days, I found that fat under my thighs, palms, hands, legs, chest, feet, and soles had been lost (it is still continuing). A swollen lymph node in my neck appeared, and my left parotid gland became swollen. I consulted an ENT. He prescribed Moxclav 625. The swelling in the parotid gland subsided, and again after some days, there was swelling, and the doctor gave me Piroxicam. Again it subsided, and then after some days, again, the same problem arose. The doctor gave me Claribid 500 for five days, and it subsided. A scan was done on my neck, and the result showed:
Enlarged left parotid gland with a diffuse decrease in echogenicity, possibly parotitis. Cervical lymphadenitis: Enlarged lymph nodes were noted in the left posterior cervical, submandibular, and upper jugular group. They show maintained fatty hilum and ovoid shape. The maximum short-axis diameter is 5 mm. Still, I am losing fat from my thighs, glute, legs, hands, chest, palms, and soles of the feet, etc. I have a burning and tingling sensation all over my body, and at night, the inside of both palms becomes red, and my veins become enlarged. The following tests I did for HIV and other STDs after the above-mentioned exposure: P24 antigen - 28th day, ELISA - 42nd day, CMIA DUO test - 75th day, ELISA - 92nd day, Hepatitis B, HCV, and VDRL - 99th day. All the above tests were negative. And doctors said that the HIV test after the 90th day was conclusive that I did not have HIV. Then please analyze my case and give me your valuable suggestions. Thank you.
Hello,
Welcome to icliniq.com.
I need to know some more information such as how much weight have you lost in the last four to six months, the presence of any other symptoms like fever, diarrhea, joints pain, recurrent oral or genital ulcer. Was there any ulcer over the scrotum during the swelling? The symptoms which you have are very non-specific and can be associated with any chronic illness. So further tests will be guided by your symptoms. Are you in touch with the lady, if yes does she have any particular illness? Firstly, there is very less likelihood of HIV, almost nil. At this stage, the possibilities I would keep are of syphilis. However, your VDRL is negative. Orit may just be a psychological issue due to overthinking about that exposure. Anyway, you will need some more investigations like complete hemogram with ESR and CRP, liver and renal function test, ANA antibody test, chest X-ray. For syphilis, you will need other tests like FTA-ABS or TPPA or MHA TP. If none of the above are informative, we may need a CT scan of the neck, chest, and abdomen. So, get back with some information, and answers to my questions. Thank you.
Patient's Query
Hello doctor,
I have not lost any weight (lost only subcutaneous fat). I do not have any fever, diarrhea, oral or genital ulcer. No ulcer or pain over the scrotum. No inguinal swelling or lymph nodes. No abdominal pain or nausea. I do not know that lady. After that exposure, I have not been in contact with her. I did CBC last week and my ESR was 16 mm/hr.
Thank you
Hello,
Welcome back to icliniq.com
So, in all probabilities, you are disease-free. You do not have any serious illness. You do not need any more tests. ESR and CRP are the markers of inflammation in the body. If you have any infection or illness, their level rises. Also, you did not lose weight. That also suggests that there is no serious illness. Regarding losing fat, I want you to document it like measure the thigh, legs, and arms diameter at the fixed point and monitor it serially over a few days. It is probably your false perception or just redistribution of fat. It is not a sign of any serious disease especially HIV or any STD. However, we need to rule out diabetes. So, get your sugars at fasting and post lunch, and also get your blood pressure checked. If you are losing fat, then you must also lose weight, right? First, regarding your parotid gland swelling, you probably had a repeated bacterial infection of the gland. It occurs in individuals with a stone in the glands pipeline or poor oral hygiene. And it has responded to antibiotics. Do you have any pain in the parotid gland region? If yes, you must get sialography done to rule out a stone and then its removal. Also, maintain good oral hygiene with mouthwash. For tingling, I suggest you have tablet Neurobion forte (multivitamin and multimineral) once a day for two to three weeks. Do you have any anxiety, stress or any sleep problems? These could play a role in your disease. Most importantly, do not worry much about the illness and try to ignore it. You do not have HIV or any serious illness. I hope that helps you and get back if you have any more doubts. Thank you.
Patient's Query
Hello doctor,
Regarding parotid gland, it was scanned. There was no stone. My oral hygiene is good. I brush twice on all days right from my childhood days. My FBS was always between 100 and 107 and PPBS 110 and 120. But when I found the loss of subcutaneous fat, the FBS suddenly moved to 133 and PPBS to 154. When I told the physician, he gave me Surbex gold and then the values returned back as earlier. My doubt is this phenomenon started when I started Doxy and Flavospas. Would it be due to a side effect of these drugs? As per the scanning of the neck, it is mentioned as cervical lymphadenitis. I have checked very clearly. There was no redistribution of fat. Before starting of this phenomenon, I was a stout person and now I am becoming lean, but the weight is not reducing. So losing of subcutaneous fat under the skin is evident. Please reply.
Thank you.
Hello,
Welcome back to icliniq.com.
It is probably because your perception has changed due to too much health anxiety. Fat has a weight, if someone is gaining it, then weight must increase or losing it, then weight must decrease. From now onwards, you measure the girth of the limbs and make a chart daily. It would be evident from this. Also, your inflammatory marker ESR is normal which rules out major illness. You can also get CRP levels done, it is also an inflammatory marker. If it is elevated then we can take necessary action. Have you been ever tested for thyroid? If not get it done. Hyperthyroidism is one of the causes of fat loss. Also, none of the drugs you had have this side effects. Also, regarding your cervical lymphadenitis, it is not truly a lymphadenitis. Because maximum size is just 5 mm which is normal for neck lymph nodes. Normally lymph nodes are present in the neck, and at least more than 10 mm is needed to call it as lymphadenitis. Also, there is not a feature of any abnormalities in the report. This mild enlargement can be due to parotitis or any viral fever, etc and it does not need investigation or treatment. So, do not worry.
Thank you.
Patient's Query
Hello doctor,
For these symptoms, what type of specialist doctor do I have to visit?
Thank you.
Hello,
Welcome back to icliniq.com.
You need to visit MD medicine personnel. He or she will do a good general examination and if something is found, he will accordingly refer you.
Thank you.
Patient's Query
Hello doctor,
Are 'general medicine' and 'medicine' the same?
Thank you.
Hello,
Welcome to icliniq.com.
Look for a degree. It should be MD in internal or general medicine.
Thank you.
Patient's Query
Hello doctor,
I did lipid profile, LFT, RFT, and TFT. Following are the details:The laboratory results indicate the following values: blood urea at 27 mg/dL, serum creatinine at 1.1 mg/dL, total cholesterol at 225 mg/dL, triglycerides at 106 mg/dL, HDL at 40 mg/dL, LDL at 164 mg/dL, VLDL at 21 mg/dL, total bilirubin at 1 mg/dL, SGOT at 22 U/L, SGPT at 30 U/L, alkaline phosphate at 126 IU/L, serum total protein at 7.3 g/dL with serum albumin at 3.7 g/dL, globulin at 3.6 g/dL, and an A/G ratio of 1:1. Thyroid function tests show T3 at 5.0 nmol/L, T4 at 7.7 nmol/L, and TSH at 4.5 mlU/L. Additionally, serum uric acid is at 5.2 mg/dL, and electrolytes are within normal range with sodium at 142 mEq/L and potassium at 4.2 mEq/L. The urine test reveals trace amounts of albumin, no urinary sugar, 2 to 4 pus cells, and 1 to 2 epithelial cells. These results provide valuable information for assessing your overall health, but their interpretation and implications should be discussed with a healthcare professional to understand their significance in your specific medical context.
Hello,
Welcome back to icliniq.com.
There is no need to worry. The reports are fine except cholesterol which is elevated. I can see you are slightly overweight. At this stage, you need lifestyle modification. You should avoid oily, fatty, high-calorie foods like sweets and sweetened beverages. You need regular exercises like running and brisk walking for at least 30 minutes a day. Try to achieve weight loss and BMI (body mass index) should be less than 23. Repeat lipid profile after three months. Also, get blood pressure checked once. Thank you.
Patient's Query
Hello doctor,
What about elevated T3 and TSH which is in borderline, also elevated globulin?
Thank you.
Hello,
Welcome back to icliniq.com.
We have to see the TSH (thyroid-stimulating hormone). If it is normal, then T3 and T4 are not that significant. A mild variation is acceptable. Also, slightly high globulin is acceptable. There is no problem in that as well. So do not worry about it.
Thank you.
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Cardiology
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