[32F] Experiencing a range of symptoms including extreme fatigue and cystic acne

Patient Description

A 32-year-old female has been experiencing extreme fatigue for the past two years, worsening since July 2023. The fatigue significantly impacts her daily activities and does not improve with rest. She has been dealing with cystic acne since age 12, currently severe, covering her cheeks, ears, jawline, neck, nasal area, and temples. Her periods have become irregular over the past two years, occurring every three weeks and lasting over a week. She also reported a significant weight loss of 60 pounds within six months last year. Additionally, she experiences blurred vision, particularly before her period, and severe dry skin that began in fall 2022. Vaginal dryness has been an issue for the past year, primarily noticed during sexual activity. She experiences teeth pain and sticky tears associated with dry eyes during her period. She has a history of pilonidal cyst and cystectomy, arthritis diagnosed at 18, and Raynaud's disease. Currently, she is on Adderall for ADHD and Propranolol for anxiety, and takes Ibuprofen as needed. She has a shellfish allergy and a slow metabolism for SSRI medications.

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Arora's Assessment

What might be happening

Based on the information you provided, possible diagnoses include:

  • Chronic Fatigue Syndrome (CFS): 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 extreme fatigue, difficulty keeping your eyes open, and the impact on your daily activities.

  • Polycystic Ovary Syndrome (PCOS): This is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. This could explain your irregular periods, acne, and weight loss.

  • Sjögren's Syndrome: This is a disorder of your immune system identified by its two most common symptoms — dry eyes and a dry mouth. Sjögren's syndrome often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. This could explain your dry eyes, dry nose, and teeth pain.

  • Hyperpigmentation: This is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin. This could explain the hyperpigmentation you've noticed on your face and other parts of your body.

What you can do

  1. Consult a doctor: It's important to consult a healthcare professional who can provide a formal diagnosis and appropriate treatment options.

  2. Keep a symptom diary: This can help you and your healthcare provider identify patterns and triggers for your symptoms.

  3. Maintain a healthy lifestyle: Regular exercise, a balanced diet, and adequate sleep can help manage symptoms of fatigue and improve overall health.

  4. Stay hydrated: Drinking plenty of fluids can help with dryness symptoms.

  5. Use a humidifier: This can help add moisture to your environment, which may help with your dry eyes, nose, and throat.

What you should look out for

Please seek immediate medical attention if you experience:

  • Severe pain or discomfort
  • Difficulty breathing
  • Signs of an allergic reaction, such as hives, swelling, or difficulty breathing
  • Any new or worsening symptoms

Please remember that while I strive to provide accurate information, I'm not a doctor. Always consult with a healthcare professional for a formal diagnosis and treatment options.

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5 mo ago

People Also Ask


What are the common symptoms of Chronic Fatigue Syndrome (CFS)?

Common symptoms of Chronic Fatigue Syndrome (CFS) include extreme fatigue that doesn't improve with rest, sleep disturbances, muscle or joint pain, headaches, sore throat, and difficulty concentrating or remembering things.


How does Polycystic Ovary Syndrome (PCOS) affect menstrual cycles?

Polycystic Ovary Syndrome (PCOS) can cause irregular menstrual cycles, which may include infrequent, prolonged, or absent periods. It can also lead to heavy bleeding during periods.


What are the typical symptoms of Sjögren's Syndrome?

Typical symptoms of Sjögren's Syndrome include dry eyes, dry mouth, joint pain, swelling, and stiffness, as well as fatigue and sometimes dry skin or rashes.


Can weight loss be a symptom of PCOS?

Yes, weight loss can be a symptom of PCOS, although it is less common. PCOS is more often associated with weight gain, but hormonal imbalances can sometimes lead to unexpected weight changes, including weight loss.


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