[20F] Experiencing multisystem symptoms including neuropathy and dysphagia

Patient Description

A 20-year-old female presents with a complex medical history, including a four-year duration of neuropathic symptoms such as tingling, numbness, and sharp pains in the hands, feet, and legs, which have recently worsened and spread. The symptoms are intermittent, predominantly nocturnal, and somewhat alleviated by heat application. She also reports difficulty swallowing solid foods, which has progressively worsened over four years, causing occasional vomiting. Dizziness with lightheadedness occurs upon standing or changing positions, a condition present for several years. She experiences lower back pain, described as achy, which has recently intensified, affecting her ability to stand or perform activities. Swelling and redness are noted at the base of her fingers, with a longstanding hard red lump on the left index finger. Night sweats and unexplained weight loss of 9 pounds over two months have been observed. Additionally, she experiences frequent kidney stones and has mildly elevated calcium levels. She has a history of PCOS, GERD, orthostatic hypotension, low MCHC/MCH/MCV levels, PTSD, Autism, ADHD, depression, anxiety, and exercise-induced wheezing. No current medications or known drug allergies. The patient also mentions shooting pains in the neck and other areas, with muscle twitchiness.

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Arora's Assessment

What might be happening

Based on the information you've provided, several conditions could be causing your symptoms:

  • Fibromyalgia: This is a chronic condition characterized by widespread pain, fatigue, sleep, memory, and mood issues. It's often accompanied by additional symptoms like numbness, tingling, and difficulty swallowing.

    • Treatment typically involves a combination of medications, exercise, stress management techniques, and healthy lifestyle habits.
  • Chronic Fatigue Syndrome (CFS): This condition causes extreme fatigue that can't be explained by any underlying medical condition. It can also cause symptoms like unrefreshing sleep, loss of memory or concentration (brain fog), dizziness that worsens with moving from lying down or sitting to standing (orthostatic intolerance), and muscle or joint pain.

    • Treatment focuses on symptom relief.
  • Sjögren's Syndrome: This is an autoimmune disorder characterized by dry eyes and mouth, which you mentioned. It can also cause fatigue and joint pain.

    • Treatment typically involves managing symptoms, often with over-the-counter and prescription drugs.
  • Hypothyroidism: Although your thyroid tests came back normal, it's worth noting that hypothyroidism can cause symptoms like fatigue, muscle weakness, pain, stiffness, or swelling in your joints, and dry skin.

    • Treatment typically involves daily use of the synthetic thyroid hormone levothyroxine.
  • Vitamin B12 deficiency: This can cause symptoms like fatigue, weakness, numbness or tingling in hands and legs, difficulty walking, swollen and inflamed tongue, and difficulty thinking and reasoning (cognitive difficulties), or memory loss.

    • Treatment typically involves B12 injections or pills.
  • Kidney stones: You mentioned having recurrent kidney stones. These can cause severe pain in the back or sides, as well as other symptoms like blood in the urine.

    • Treatment typically involves pain relievers and drinking lots of water to help pass the stone. Medical procedures may be needed to remove or break up larger stones.

Please note that this is not an exhaustive list of all possible conditions that could be causing your symptoms. It's also possible that you could be experiencing more than one condition at the same time.

What you can do

Given the range and duration of your symptoms, it's important to seek medical attention. Here are some steps you can take:

  1. Schedule an appointment with your primary care doctor. If you don't have one, try to find a doctor who specializes in diagnosing and treating conditions like fibromyalgia or chronic fatigue syndrome.
  2. Write down all of your symptoms, even if they seem unrelated to each other. This can help your doctor understand what's going on.
  3. Write down key personal information, including any major stresses or recent life changes.
  4. Make a list of all medications, vitamins, or supplements that you're taking.
  5. Consider taking a family member or friend along to help you remember all the information provided during your appointment.

What you should look out for

Seek immediate medical attention if you:

  • Have severe pain
  • Have trouble breathing
  • Have changes in vision
  • Have difficulty walking
  • Have severe weakness or difficulty moving any part of your body
  • Have symptoms that interfere with your daily activities or quality of life

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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11 mo ago

People Also Ask


What are the common symptoms of fibromyalgia?

Common symptoms of fibromyalgia include widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive difficulties (often referred to as 'fibro fog'), and sometimes numbness or tingling in the hands and feet.


How can vitamin B12 deficiency affect the body?

Vitamin B12 deficiency can lead to symptoms such as fatigue, weakness, numbness or tingling in the hands and feet, difficulty walking, swollen and inflamed tongue, and cognitive difficulties or memory loss.


What lifestyle changes can help manage chronic fatigue syndrome?

Lifestyle changes that can help manage chronic fatigue syndrome include establishing a regular sleep routine, pacing activities to avoid overexertion, managing stress through relaxation techniques, and maintaining a balanced diet. Gentle exercise, such as walking or swimming, may also be beneficial.


What are the treatment options for recurrent kidney stones?

Treatment options for recurrent kidney stones include increasing fluid intake to help pass stones, using pain relievers, and sometimes medications to prevent stone formation. In some cases, medical procedures like shock wave lithotripsy or surgery may be necessary to remove or break up larger stones.


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