[30F] Experiencing welts, fatigue, and lethargy

Patient Description

A 30-year-old female has been experiencing welts on her arms, legs, and feet, along with significant fatigue and lethargy for the past 3 months. She describes her fatigue as being exhausted regardless of sleep duration, accompanied by a constant feeling of being achy and a dull body ache rated at a severity of 6 out of 10. The patient has a history of endometriosis diagnosed in 2012 and ADHD diagnosed in 2016. She is currently taking Adderall for ADHD and Zyrtec for the hives. She has not noticed any weight changes and has no known drug allergies. No other medications have been reported.

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Arora's Assessment

What might be happening

Based on your symptoms, possible diagnoses include:

  • Chronic Urticaria: This is a condition where hives or welts appear on the skin, last for more than six weeks, and often come and go. These hives can be associated with fatigue and body aches. The exact cause is often not identified, but it can sometimes be linked to an autoimmune response.

    • Treatment typically involves antihistamines, like Zyrtec, which you are already taking.
  • Chronic Fatigue Syndrome (CFS): This is a complex disorder 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. Body aches are also a common symptom of CFS.

    • Treatment usually focuses on symptom relief.
  • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It amplifies painful sensations by affecting the way your brain processes pain signals.

    • Treatment often involves a combination of medications, exercise, stress-management measures and healthy lifestyle habits.

Please note that these are just possibilities and not a definitive diagnosis. It's important to consult with a healthcare professional who can evaluate your symptoms and medical history in order to provide an accurate diagnosis.

What you can do

  1. Continue taking your allergy medication as directed by your healthcare provider.
  2. Try to maintain a regular sleep schedule. This can sometimes help manage fatigue.
  3. Gentle exercise, such as walking or swimming, can sometimes help with body aches and fatigue. However, it's important to start slowly and not push yourself too hard.
  4. Keep a symptom diary. Note when your symptoms occur, what you're doing at the time, and any potential triggers. This can be helpful information to share with your healthcare provider.

What you should look out for

If your symptoms worsen or if you develop new symptoms, it's important to seek medical attention. Specifically, you should contact a healthcare provider if:

  • Your hives become more widespread or painful
  • Your fatigue or body aches become so severe that they interfere with your daily activities
  • You develop new symptoms, such as unexplained weight loss, fever, or persistent headaches

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 causes of chronic urticaria?

Chronic urticaria can be caused by autoimmune responses, infections, stress, or sometimes no identifiable cause. It involves hives that last for more than six weeks and can be associated with other symptoms like fatigue.


How is chronic fatigue syndrome diagnosed?

Chronic fatigue syndrome is diagnosed based on a thorough medical history, physical examination, and ruling out other conditions. There are no specific tests for CFS, so diagnosis often involves identifying a pattern of symptoms and excluding other possible causes.


What lifestyle changes can help manage fibromyalgia symptoms?

Lifestyle changes that can help manage fibromyalgia include regular low-impact exercise, stress management techniques, maintaining a healthy sleep routine, and a balanced diet. Cognitive behavioral therapy and support groups can also be beneficial.


Can ADHD medication like Adderall affect fatigue levels?

Adderall, a stimulant used to treat ADHD, can sometimes cause side effects like insomnia or increased energy, which might affect fatigue levels. However, it can also help improve focus and energy in individuals with ADHD. It's important to discuss any concerns with a healthcare provider.


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