[22F] Experiencing a range of persistent symptoms

Patient Description

A 22-year-old female presents with a complex of symptoms persisting for several months. She reports constant fatigue that is not alleviated by rest, and experiences 'hitting walls' throughout the day despite adequate sleep. Additionally, she has been having a low-grade fever between 99 and 100.1 degrees Fahrenheit for a couple of months, cold feet, and frequent night sweats occurring approximately 5 nights per week. The patient also describes a persistent itchy rash, primarily on her shins and neck, lasting for about 6 months, and a constant nasal drip present for at least a year. She experiences brain fog, has swollen and sore submandibular lymph nodes, and occasional fuzzy vision. The patient notes easy and random bruising on her arms and legs for at least a year. She has no known drug allergies and is not currently on any medications. There is a family history of autoimmune disorders, and the patient has had premelanoma lesions diagnosed a month ago. No recent travel, substance use, or significant changes in diet were reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, there are several possible explanations for your symptoms:

  • Chronic Fatigue Syndrome: This condition is characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue worsens with physical or mental activity, but doesn't improve with rest. This could explain your constant fatigue, brain fog, and abnormal sleep.

  • Post-Acute Sequelae of SARS-CoV-2 infection (PASC), also known as Long COVID: Some people who have had COVID-19 continue to experience symptoms or develop new ones months after the resolution of their acute illness. This could explain your low-grade fever, fatigue, and brain fog.

  • Autoimmune diseases: Given your mother's history of Sjogren's syndrome, an autoimmune disease, and your symptoms of fatigue, low-grade fever, rash, and swollen lymph nodes, it's possible you could have an autoimmune disease. Many autoimmune diseases can cause these symptoms, including lupus and rheumatoid arthritis.

  • Lymphoma: This is a type of cancer that begins in the lymphatic system. The swollen lymph nodes, night sweats, weight gain, and easy bruising could be symptoms of this condition.

  • Allergic reaction or Dermatitis: This could be causing your itchy rash and nasal drip.

Please note that these are possibilities based on the information you've provided, and not a definitive diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis.

What you can do

  1. Schedule an appointment with your primary care provider as soon as possible to discuss your symptoms. They may refer you to a specialist, such as a rheumatologist or hematologist, for further evaluation.

  2. Keep a symptom diary. Note when each symptom occurs, its severity, and any potential triggers. This can help your healthcare provider in diagnosing your condition.

  3. Try to maintain a healthy lifestyle. Eat a balanced diet, engage in regular physical activity, ensure you're getting enough sleep, and manage stress. While these actions may not directly address your symptoms, they can boost your overall health and may help you feel better.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe difficulty breathing or shortness of breath
  • Severe chest pain or pressure
  • New confusion, or inability to wake or stay awake
  • Bluish lips or face
  • Any other severe or concerning symptoms

Remember, this advice is intended to be supportive and informative but does not replace professional medical advice.

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10 mo ago

People Also Ask


What are the common symptoms of Chronic Fatigue Syndrome?

Common symptoms of Chronic Fatigue Syndrome include severe fatigue that doesn't improve with rest, sleep disturbances, muscle or joint pain, headaches, sore throat, and cognitive difficulties such as brain fog.


How can Long COVID affect someone months after the initial infection?

Long COVID can cause a variety of symptoms that persist for weeks or months after the initial infection, including fatigue, brain fog, shortness of breath, joint pain, and chest pain. Some people may also experience new symptoms that were not present during the acute phase of the illness.


What are the signs and symptoms of an autoimmune disease?

Signs and symptoms of autoimmune diseases can vary widely but often include fatigue, joint pain and swelling, skin problems, abdominal pain or digestive issues, recurring fever, and swollen glands. Specific symptoms depend on the type of autoimmune disease.


What should I do if I suspect I have lymphoma?

If you suspect you have lymphoma, it is important to see a healthcare provider for a thorough evaluation. They may perform blood tests, imaging studies, and possibly a biopsy of the lymph nodes to confirm the diagnosis. Early diagnosis and treatment are crucial for the best outcomes.


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