[21F] Experiencing a range of symptoms including facial flushing and stomach pain

Patient Description

A 21-year-old female reports a 4-year history of intermittent facial flushing, characterized by extreme redness in the cheeks and ears accompanied by a burning sensation, which is triggered by bending down or exposure to heat. Additionally, she experiences stabbing stomach pain radiating to the chest and upper back, rated at 7.5/10 for severity, which is alleviated by bending over. She also describes various types of headaches, vision disturbances with floaters, and itchiness in her legs and feet after warm showers, a symptom present since age 9. She experiences night sweats a few times per month and has a penicillin allergy. The patient is currently on testosterone therapy and has no other known pre-existing conditions or chronic illnesses.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Polycythemia Vera: This is a slow-growing blood cancer where your bone marrow makes too many red blood cells. These excess cells thicken your blood, slowing its flow, which may cause serious complications, such as blood clots. The symptoms you've described, including facial flushing, headaches, tiredness, and feeling full quickly after eating, are common in Polycythemia Vera.

    • Treatment often involves procedures to reduce the number of red blood cells in your body and medications to decrease the production of blood cells in the bone marrow.
  • Gastritis or Peptic Ulcer Disease: These conditions involve inflammation or erosion of the stomach lining, which can cause pain that radiates to the back and chest. Feeling full quickly after eating is also a common symptom.

    • Treatment typically involves medications to reduce stomach acid and possibly antibiotics if a bacterial infection is present.
  • Migraines: These are a type of headache characterized by severe pain on one side of the head, often accompanied by other symptoms such as visual disturbances (floaters) and sensitivity to light and sound.

    • Treatment typically involves medications to relieve symptoms and prevent future attacks.
  • Dermatographia: This is a condition also known as "skin writing", where lightly scratching your skin causes raised, red lines where you've scratched. This could explain the itchiness and redness you experience on your legs and feet after warm showers.

    • Treatment typically involves antihistamines to reduce the itchiness and redness.

Please note that these are possible diagnoses based on the symptoms you've described. It's important to consult with a healthcare provider for a formal diagnosis and treatment plan.

What you can do

  1. Schedule an appointment with your healthcare provider to discuss your symptoms. They may order tests, such as blood tests or an endoscopy, to help determine the cause of your symptoms.
  2. Keep a symptom diary. Note when your symptoms occur, what you're doing at the time, and what foods you've eaten. This may help identify triggers or patterns to your symptoms.
  3. Try to maintain a healthy lifestyle. Eat a balanced diet, exercise regularly, and ensure you're getting enough sleep. This can help manage some of your symptoms and improve your overall health.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe, sudden, or worsening abdominal pain
  • Difficulty breathing or shortness of breath
  • Sudden, severe headache or changes in vision
  • Any new or worsening symptoms

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 appropriate examination, testing, and care recommendations.

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11 mo ago

People Also Ask


What are the common symptoms of Polycythemia Vera?

Common symptoms of Polycythemia Vera include facial flushing, headaches, dizziness, fatigue, itching (especially after a warm shower), and a feeling of fullness or bloating in the abdomen due to an enlarged spleen.


How can gastritis or peptic ulcer disease cause pain that radiates to the back and chest?

Gastritis or peptic ulcer disease can cause pain that radiates to the back and chest because the inflammation or erosion of the stomach lining can affect nearby nerves and tissues, leading to referred pain in these areas.


What are the typical symptoms and triggers of migraines?

Typical symptoms of migraines include severe, throbbing pain usually on one side of the head, nausea, vomiting, and sensitivity to light and sound. Triggers can include stress, certain foods, hormonal changes, and environmental factors.


What is dermatographia and how is it treated?

Dermatographia is a condition where lightly scratching the skin causes raised, red lines. It is often treated with antihistamines to reduce itchiness and redness, and avoiding known triggers such as hot showers or tight clothing can help manage symptoms.


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