Dr. Goswami Parth Rajendragiri
Pathology
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 have been having multiple issues for one year now. Mostly around lack of energy, feeling spaced out, feeling faint, weight loss and stomach. For 8 weeks, my occipital lymph node is hard maybe about 0.39 inch in size. It is in line with my left ear lobe and on the hairline. So not right behind my ear but more towards the back of my head. I have been having strange on and off headaches, shoulder aches or flu like symptoms but without fever. I can feel good for a week then I am just whacked out tired and low for a week. Physical activities just makes me feel weak and shaky. Last night I woke up in the night with random face, ear, neck itching but not all over. It would be pin point and changes position. Never had this in my life.
I also have low testosterone and using Testogel for nine months. My last two blood controls showed all bloods to be normal with basophils at 1 % but the absolute basophils were 120 /µL (normal range states 10 to 70/µL). The second control from one week ago showed same results. Bloods from one year ago showed normal absolute results and a lower basophilia percentage at 0.7 %.
Sometimes, I am also having episodes where it is like an allergic reaction and I cannot breathe so good or my throat is closing. This is quite frightening and I get panic. Usually sleep helps this. So I am wondering if there is a link between the node and the absolute basophils. Do I need to get any further tests?
Hello,
Welcome to icliniq.com.
I have read your concern and below is my opinion for your case.
The itching, headache, flu like symptoms and throat blockage are suggestive of some form of allergic inflammation of upper respiratory tract. The basophils count is also slightly high, so allergic inflammation seems most likely (attachment removed to protect patient identity). During that allergic episode you can be prescribed Levocetirizine plus Montelukast combination for five to seven days.
The allergic inflammation can cause fatigue as well. If your fatigue is persistent than investigate further with calcium estimation, serum TSH estimation for further work up to exclude any low calcium and hypothyroid problem. For allergy, you can be investigated for allergy testing by allergy specialist doctor to find out causative allergen. The enlarged lymph node can be reactive enlargement of lymph node. But if it is persistently enlarged, then investigate further with FNAC for further work up to rule out nature of enlarged node. The node can be enlarged due to allergic inflammation as well. So it can be related to high Basophil.
Your cholesterol value is also slightly high. So, you need to control fat intake in diet and do regular exercise. If you are obese, then lose weight by diet and exercise. Finally, let me tell you that anxiety and chronic depression also can cause weakness. So if any such history is present then let me know about that.
Patient's Query
Thank you doctor,
Just so you know I did have full allergy workup done with both bloods (celiac, IgA, etc.) and a skin prick test with over 50 allergens. Everything was negative except for having elevated eosinophil cationic protein in my blood at 66.7 ug/l. Doctors said it was normal in general.
Hello,
Welcome back to icliniq.com.
It is good that your allergic testing report is negative (attachment removed to protect patient identity). So, flu-like symptoms and throat blockage can be due to viral inflammation or some unknown allergic inflammation. The treatment for that include decongestant as suggested above for five days course during episode. Your detailed chest evaluation especially auscultation examination by stethoscope should be done for hearing respiratory sound. You can investigate with FNAC or biopsy for the enlarged node, serum TSH estimation and calcium estimation as suggested in the above answer. If you have any anxiety problem, then mention it.
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Pathology
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