Q. What is the exact issue of my health?

Answered by
Dr. Sadaf Mustafa
and medically reviewed by iCliniq medical review team.
Published on Jun 28, 2016 and last reviewed on: Sep 16, 2019

Hi doctor,

I am an 18 year old female. I am suffering through a number of physical issues since two years. At first, it all started from sudden loose motion. I often got admitted in hospital for this reason. I visited many reputed doctors, but none of them was able to reach any conclusion. At last I was declared celiac, however, it was not the case. Suddenly, without any medications my loose motion has stopped. It was weird, but I was relieved. Soon after two to three days my right chest started hurting a lot. I could not walk, breathe or sleep. I got an x-ray done and it revealed that I had pleural effusion in my right side of chest. Doctor took out 20 mL of urine colored liquid and sent it for laboratory testing. My ADA was high, but malignant cells were not present. So, the doctor reached the conclusion that I have closed TB. I took the TB medicines for four months. I had very ups and downs in my health in those months and suffered through loose motions often.

I changed my doctor for a second opinion. He said that I have major swelling in my lungs and it can get worse if I inhale air pollutants as I was allergic to smoke and dust. He told me to get a good amount of rest and not to climb stairs or walk much. At first, I daily had mild temperatures and had shortness of breath the whole day. I thought I was getting better, but one day suddenly my ankles, upper area of foot, side and back of knees, front of the elbow and my back started aching badly. I suffered through this pain for days as I thought it was normal a body pain, but the pain got worse. I had severe weakness and often had floaters in my vision. I also lost weight and now I am underweight of 42 kg with a height of 5'4". I could not walk or climb stairs as my feet tremble a lot with tremendous pain. It was as if I am not in my senses. I had an eye infection. I got a small pimple like things all over my shoulder and back. My breathing problems got worse. I visited my doctor and he said my lungs are getting worse day by day and a certain disease will get activated if I push myself hard. He also said that I cannot continue my studies this year. I have to rest properly, however, he said that I can walk until I face any abnormalities in my breathe. But, I cannot walk for five to six minutes without taking rest. It means I can only wander in my house a little. It is just ruining my life. I have attached my current medications list. I cannot understand what is this about. What is the exact issue with my body?

Dr. Sadaf Mustafa

General Medicine Internal Medicine


Welcome to icliniq.com.

I am so sorry to hear all that you have been going through and here is my thought process.

  • Did you have any work up for that? Also, we have to prove if you had tuberculosis or did you had PPD (purified protein derivative) or culture or gamma interferon test?
  • Please upload any investigations you have, I will list the ones I need to know.

Investigations to be done:

CBC - complete blood count, urea and electrolytes, liver function test, ANA (antinuclear antibody) with characterization and anti-SM antibodies and Anti-dsDNA antibodies if not done. CT scan of the chest with contrast, if the kidney function is normal.

Regarding follow up:

Revert back with the investigation reports to an internal medicine physician online.---> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

No, my doctor did not tell me to go through all these tests. However, I had liver function test and the doctor said everything is normal. But, I have slight infection and ADA was 85 something. Is this all something to do with COPD as I have major lung issues and breathing problems too? I cannot walk or do any kind of physical activity. I sleep almost throughout the day. My feet and hands tremble a lot. The thing that draws my attention most is that my face looks fat and the body is relatively thin. It is a kind of swelling, but it does not hurt and it is not stiff. The body pain is still there. I can barely walk. What probably causes all this?

Dr. Sadaf Mustafa

General Medicine Internal Medicine


Welcome back to icliniq.com.

  • The ADA (serum adenosine deaminase) is high; I agree, but to prove that you have TB or if you have multidrug resistance tuberculosis pleural effusion we would need pleural culture and pleural biopsy.
  • I wanted to know if you have any results from the plural fluid that made your doctor change your treatment? Also, did you took four medications in the first two weeks and then changed to two drugs? If yes, what did you took in the first two months?
  • I would still want you to do these investigations as I requested if possible.
  • No, you do not have COPD. It may be hyper reactive airway due to the infection.
  • We would have to rule out autoimmune disease and also make sure that you have a recent chest x-ray, maybe you are accumulating more fluid?
  • Remember, if it is TB; it might be multidrug resistance and you may not be responding to the treatment. That is why you feel tired and body pain. You should be taking 50 mg vitamin B6 daily, the dose that you are taking is less.

For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

I remember that I took one more medicine first with Combunex Rcin and Helirab, it was Veloz. But, it was removed from the prescription after one month. One surprising fact is that the urine colored liquid from my chest area disappeared within 20 days. The x-ray came clear after 20 days of treatment. The liquid took out was only 20 mL and 75% of my right chest showed white in the x-ray. The last x-ray taken was 20 days ago. It was clear, but the lungs were expanded or more accurately swelled up unusually. And for other tests, I asked a number of times to my doctor, but he always mentions only x-ray and blood tests. He says there is nothing big. We are just giving this treatment to prevent anything big to happen. He makes a big deal out of this disease, but never mentioned exactly what the disease is. He says I am allergic to pollutants and these are damaging my lungs. He says that certain disease will get activated and my life will get spoiled, although I am not sure what this disease is. May be he refers to TB or pleurisy or COPD. All that he mentions is that I am allergic to dust and other pollutants.

Dr. Sadaf Mustafa

General Medicine Internal Medicine


Welcome back to icliniq.com.

  • My feeling is that they are talking about TB, since it can reactivate during the time of stress.
  • Are you seeing a pulmonologist or infectious disease specialist or just a general practitioner? My advice is to go with a specialist.

For further doubts consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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