[24F] With widespread pain, neurological, and systemic symptoms

Patient Description

A 24-year-old female presents with persistent deep, sharp bone pain in the back and shoulders since November 2023, rated 8-9/10, worsening during menstruation. The pain is constant and only relieved by ER medication. She experiences migraines with throbbing pain and episodes of blurry vision since January. Additional symptoms include fatigue, numbness, tingling in fingers and legs, muscle weakness in arms and legs, balance issues requiring a cane, and extremely high blood pressure with moderate LVH. Digestive issues include daily diarrhea, blood in stool, vomiting, and stomach pain. Skin symptoms include rashes, dry mouth and eyes, and easy bruising. Neurological concerns involve shaking, muscle spasms, insomnia, and cognitive difficulties. An EEG indicated significant nerve and muscle issues in the arms. Family history suggests possible lupus and MS, though ANAs were negative. Current medications include Gabapentin (800mg 3x/day), Celebrex (100mg 2x/day), Cymbalta (60mg 1x/day), and unspecified stomach and nausea medications.

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Arora's Assessment

What might be happening

Your symptoms suggest a complex condition that may involve multiple underlying issues. Here are some possibilities:

  1. Autoimmune Disorders: Conditions like lupus or multiple sclerosis could explain many of your symptoms, such as fatigue, joint pain, rashes, and neurological issues. Even with negative ANA tests, further evaluation might be needed.

  2. Neurological Conditions: The lesions on your brain and symptoms like numbness, tingling, and muscle weakness could indicate a neurological condition. Multiple sclerosis or another demyelinating disease might be considered.

  3. Fibromyalgia or Chronic Pain Syndrome: These could explain widespread pain, fatigue, and cognitive difficulties.

  4. Cardiovascular Issues: High blood pressure, heart palpitations, and dizziness could be related to cardiovascular problems, possibly linked to your moderate LVH.

  5. Gastrointestinal Issues: Chronic diarrhea, blood in stool, and stomach pain might suggest inflammatory bowel disease or another gastrointestinal disorder.

What you can do

Pain Management:

  • Continue taking prescribed medications and discuss any changes with your doctor.
  • Consider physical therapy to help manage pain and improve mobility.

Neurological Symptoms:

  • Follow up with a neurologist for further testing, such as MRI or lumbar puncture, to explore neurological causes.
  • Keep a journal of symptoms using MDandMe to track patterns and triggers.

Cardiovascular Health:

  • Monitor your blood pressure regularly and follow your doctor's advice on managing it.
  • Maintain a heart-healthy diet and engage in gentle exercise as tolerated.

Gastrointestinal Health:

  • Keep a food diary to identify any dietary triggers for your symptoms.
  • Stay hydrated and follow any dietary recommendations from your healthcare provider.

General Health:

  • Prioritize rest and manage stress through relaxation techniques like meditation or yoga.
  • Ensure regular follow-ups with your healthcare team to address ongoing concerns.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe chest pain or difficulty breathing.
  • Sudden changes in vision or consciousness.
  • New or worsening neurological symptoms, such as severe weakness or numbness.

Remember, it's important to work closely with your healthcare providers to get a comprehensive evaluation and appropriate treatment.

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3 mo ago

Top picked over-the-counter products for Tingling or Cold Sensations at the Back of Your Head

People Also Ask


What could be causing persistent deep bone pain and how is it related to menstruation?

Persistent deep bone pain that worsens during menstruation could be related to hormonal changes or underlying conditions such as fibromyalgia or an autoimmune disorder. It's important to discuss these symptoms with a healthcare provider for proper evaluation and management.


How can neurological symptoms like numbness, tingling, and muscle weakness be evaluated?

Neurological symptoms like numbness, tingling, and muscle weakness can be evaluated through a combination of clinical examination, imaging studies like MRI, and possibly a lumbar puncture. These tests help identify conditions such as multiple sclerosis or other neurological disorders.


What are the potential causes of high blood pressure and moderate left ventricular hypertrophy in young adults?

High blood pressure and moderate left ventricular hypertrophy (LVH) in young adults can be caused by genetic factors, lifestyle, or underlying health conditions such as kidney disease or hormonal disorders. It's crucial to monitor blood pressure and work with a healthcare provider to manage these risks.


What gastrointestinal conditions could cause daily diarrhea, blood in stool, and stomach pain?

Gastrointestinal conditions that could cause symptoms like daily diarrhea, blood in stool, and stomach pain include inflammatory bowel disease (IBD), infections, or other inflammatory conditions. A thorough evaluation by a gastroenterologist, including possible endoscopy or imaging, is recommended to determine the cause.


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