What could be the reason for long-standing lightheadedness and nausea in a patient with elevated lymphocyte levels?

Question

Hello doctor,

I have had lightheadedness and nausea for the past six months. When I consulted the doctors, I found out I had typhoid. I took the prescribed medicines, and typhoid was cured, but I still have lightheadedness and nausea. When I consulted other doctors, I realized I had low levels of vitamin B12, so I started taking the medication. My lightheadedness improved slightly and my vitamin B12 level after three weeks of medication jumped to 650 pg/mL, but I started feeling nauseous again. I realized my vitamin B12 levels have again dropped to 191 pg/mL. My lymphocyte levels are going up. A month ago, they were 47.9 %, and now, they are 50.3 %. I have lightheadedness and nausea even after taking the medications. Why do I have nausea and lightheadedness all the time?

Answer 1

Hello,

Welcome to icliniq.com.

Lightheadedness and nausea could not be only due to vitamin B12 deficiency. Your blood pressure needs to be checked as hypertension is also a reason for chronic headaches. Migraine is also another differential diagnosis for headache with nausea. I suggest you visit a neuro physician for physical examination and the management of headaches. The attached report (attachments removed to protect the patient's identity) does not suggest any specific pathology except a high lymphocyte count. Lymphocyte count could be high due to chronic inflammation in the body. If the lymphocyte count is persistently high for more than three months, flow cytometry can be done for further work up. If needed, stool culture can be done to rule out typhoid.

Answer 2

Hello,

Welcome back to icliniq.com.

I suggest you continue Vitamin B12 supplements or injections for the prescribed duration (consult a specialist doctor, discuss with them, and take medications with their consent). Your otological evaluation and neurological examination are needed for further work up. Lymphocyte count is usually high in viral infection. However, if it persists for more than three months, further evaluation in the form of flow cytometry is needed.