[38F] Experiencing significant systemic symptoms with a complex medical history

Patient Description

A 38-year-old female presents with a year-long history of progressively worsening and spreading swollen lymph nodes, severe drenching sweats especially during sleep, and unintentional weight loss of 10 lbs over the past month. She reports a sensation of starvation and muscle wasting, despite a decreased capacity to eat, which began 1 and 1/2 months ago. The patient has also been experiencing chest pains rated 4/10 in severity, which radiate to the back and are exacerbated by sitting and lying down. There is a history of uncontrollable vomiting for a month, now resolved, but with ongoing nausea and a feeling of a 'shrunk' stomach. Additional symptoms include dizziness, fatigue, hair loss, ringing in ears, numb lower lip, and left abdominal pain. The patient has a complex medical history with a diagnosis that has fluctuated between ANCA vasculitis, lupus, and Sjogren's syndrome, and has been on hydroxychloroquine 400 mg daily for 2 years. There is a family history of breast cancer, lymphoma, and possible autoimmune diseases. The patient's laboratory history shows fluctuating ANA patterns and a history of anemia and low lymphocyte count.

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Arora's Assessment

What might be happening

Based on the information you have provided, possible diagnoses include:

  • Lymphoma: This is a type of cancer that originates in the lymphatic system, which is part of the body's immune system. Symptoms can include swollen lymph nodes, unexplained weight loss, severe night sweats, and fatigue.

    • Diagnostic tests for lymphoma typically include blood tests, imaging tests, and a biopsy of the swollen lymph nodes. Treatment usually involves chemotherapy, radiation therapy, and in some cases, stem cell transplant.

  • Autoimmune conditions: Given your possible diagnoses of ANCA vasculitis, lupus, or Sjogren's syndrome, these conditions could explain some of your symptoms. Autoimmune conditions occur when your immune system mistakenly attacks your own body.

    • Treatment typically involves managing symptoms and preventing complications, and can include medications like hydroxychloroquine, which you are currently taking.

  • Infections: Certain infections can cause symptoms similar to what you're experiencing, such as swollen lymph nodes, night sweats, and weight loss.

    • Treatment would depend on the specific type of infection, and could include antibiotics or antiviral medications.

Please remember that while these are possible diagnoses, only a healthcare professional can provide a definitive diagnosis.

What you can do

  1. Seek immediate medical attention: Given the severity and duration of your symptoms, it's important to seek medical attention as soon as possible. Your symptoms are concerning and require a thorough evaluation by a healthcare professional.

  2. Keep a symptom diary: Documenting your symptoms, including when they occur, their severity, and any potential triggers, can be helpful information for your healthcare provider.

  3. Maintain a balanced diet and stay hydrated: Even though you're experiencing stomach upset and a decreased appetite, try to eat small, frequent meals and stay hydrated. This can help prevent further weight loss and dehydration.

What you should look out for

  • Worsening of symptoms: If your symptoms worsen or if you develop new symptoms, seek medical attention immediately.
  • Signs of infection: Fever, chills, and increased swelling or redness of the lymph nodes could indicate an infection, which would require immediate medical attention.
  • Severe chest pain or difficulty breathing: These could be signs of a serious condition and require immediate medical attention.

Remember, I'm an AI and this advice is based on the information you've provided. It's important to consult with a healthcare professional who can evaluate your symptoms and condition in person.

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9 mo ago

People Also Ask

What are the common symptoms of lymphoma?

Common symptoms of lymphoma include swollen lymph nodes, unexplained weight loss, severe night sweats, fatigue, and sometimes fever. These symptoms occur because lymphoma affects the lymphatic system, which is part of the body's immune system.

How can autoimmune diseases like lupus or Sjogren's syndrome affect the body?

Autoimmune diseases like lupus or Sjogren's syndrome can cause the immune system to attack healthy cells, leading to symptoms such as joint pain, fatigue, skin rashes, and organ inflammation. These conditions can affect various parts of the body, including the skin, joints, kidneys, and other organs.

What diagnostic tests are typically used to identify lymphoma?

Diagnostic tests for lymphoma typically include blood tests to check for abnormal cells, imaging tests like CT or PET scans to look for enlarged lymph nodes, and a biopsy of the lymph nodes to examine the cells for cancer. These tests help determine the presence and extent of lymphoma.

What are the potential side effects of taking hydroxychloroquine for autoimmune conditions?

Potential side effects of taking hydroxychloroquine include nausea, stomach cramps, headache, dizziness, and in some cases, changes in vision. Long-term use requires regular monitoring by a healthcare provider to manage any adverse effects and ensure the medication's effectiveness.

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