Dr. Shubadeep Debabrata Sinha
Infectious Diseases
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 am a 45-year-old male. I had a body-to-body massage 20 months ago. The massage includes sexual intercourse with multiple girls. I have completely abstained from such activities for the past 18 months. I took tablet Doxycycline 100 mg twice a day for one month after that massage. I have been experiencing itching near my hip area for the past four months, and some boils are developing in my buttocks. It gets burst and then reappears on a different site. And I also got boils in my neck, and when I tried to poke them, pus was drained. After that, I developed multiple lymph nodes swelling on the right side of my neck with severe itching in the back of my neck.
Six months ago, I also had nausea, cough, and blood in my sputum for a week. Then I took tablet Augmentin and Mucolite, and it resolved. My blood report showed low serum globulin levels. I have attached my recent blood reports, scan reports, and photographs of the boils.
My main worries are:
My weight loss, lymph node swelling, and itching. My father's weight loss. My mother's neck bump.
My parents are also having serum globulin below the normal range.
So, I feel it is something contiguous, and possibly I might have spread it to them.
Please go through all the reports and pictures and advise.
Hello,
Welcome to icliniq.com.
I saw your reports (attachments removed to protect the patient’s identity).
As you had protected intercourse, you seem to have saved yourself from HIV (human immunodeficiency virus), HBV (Hepatitis B virus), syphilis, gonorrhea, treponema, and tuberculosis. Also, you seem to have corrected the course by taking prophylactic antibiotics like Doxycycline.
But you could have acquired viral diseases like CMV (cytomegalovirus) and EBV (Epstein Barr virus) through deep kissing. IgG positivity and lymph nodes enlargements are the collaborating sign of viral infection. You also seem to have a different diagnosis of cholelithiasis (gall bladder calculi). As you have significant weight loss, we need to consider a differential diagnosis for oncologic etiopathology.
Kindly do the following tests;
1) Abdominal CT (computed tomography) or preferably a whole-body CT scan.
2) Immunophenotyping in the peripheral blood.
Revert with the reports.
Thanks.
The Probable causes
Differential diagnosis
Probable diagnosis
Treatment plan
Regarding follow up
Patient's Query
Thank you doctor,
Thanks a lot for your reply. I appreciate you reading my reports thoroughly and providing an appropriate response. As for your query on the infection symptoms, I had some boil in my buttock, and it got resolved six months back (picture attached). I have itching in the back of the neck, back of the forearm, and near the hip area. Now, most of the itching got resolved except some in my back, which is occasional. My forehead skin got darkened a little bit when I observed carefully (picture attached). I had blood in my sputum for four to five days, and it got resolved ten months back. I had a weight loss of 33 lbs, and I am losing my hair as well slowly. As for weight loss, I gain weight of one to two kilograms when I eat during the day (I am eating more nowadays), and then I get up on the next day and end up losing that weight gained during the day. I will get the CT scans done for the whole body and the blood test you have suggested.
I have some specific queries:
a) CMV/EBV:
IgM is negative, but IgG is positive.
If IgM is negative, does it indicate only past infection? Or do you still suspect that I have them now because of positive IgG?
b) Neuroviruses comprehensive panel qualitative PCR:
This test seems to cover every virus. Would you suggest this test to find out whether I have an active viral infection? Also, should I give a CSF sample? or a blood sample is enough for this?
c) infectious mononucleosis:
I heard about mono or monospot test diagnose this condition. Is this available here?
d) Can the viral infection be HSV 6 or 7 or 8 or measles or chickenpox?
Do any blood or CSF tests help to diagnose them?
d) Lymphoma:
Can lymph nodes turn cancerous because of viral infection. Is that a possibility? I appreciate your time and help.
Hi,
Welcome back to icliniq.com.
Thanks for your query. I am replying in reverse order.
d) It is not about infection turning cancerous. Usually, there is a differential diagnosis that should be ruled out in addition to confirming the main diagnosis.
c) The infection could be HSV (herpes simplex virus) or chickenpox. In either case, diagnosis is primarily clinical, and in certain laboratory tests, both antigen and antibody detection are available. The infectious mononucleosis test, the monospot test, is available, and it should be done in your case.
b) Blood sample versus CSF (cerebrospinal fluid) sample - mostly blood sample should suffice. CSF samples may be required based on clinical requirements by the treating doctors. Overall keep taking precautions and treatments as what you have done until now.
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