[40F] With chronic fatigue, spreading rash, and other symptoms

Patient Description

A 40-year-old female has been experiencing significant fatigue for over a year, which is exacerbated by stress and can last for weeks at a time. The fatigue is severe enough that she can sleep all day. Additionally, she has had a rash for over a month that is itchy, red, and bumpy, and it has been spreading. She also reports experiencing fever, night sweats for over a year, and body aches. There is no unusual bruising or bleeding. The patient has not been diagnosed with any autoimmune diseases or blood disorders in the past and has not started any new medications or supplements in the past year. She vapes nicotine daily. There is a family history of Hashimoto's disease and rheumatoid arthritis (RA). She is currently taking Celexa daily but is unsure of the dosage. She is not taking any other prescription or over-the-counter medications and does not have any medication allergies.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations:

High Platelet Count with Rash, Fatigue, and Night Sweats

  1. Chronic Inflammatory Conditions:

    • Rheumatoid Arthritis (RA): Given your family history of RA, it's possible that an inflammatory condition could be contributing to your symptoms. RA can cause systemic symptoms like fatigue and night sweats, and inflammation can lead to elevated platelet counts.
    • Hashimoto's Thyroiditis: This autoimmune condition, also present in your family history, can cause fatigue and other systemic symptoms. However, it is less likely to cause a rash or high platelet count directly.
  2. Hematologic Disorders:

    • Essential Thrombocythemia: This is a condition where the bone marrow produces too many platelets, which can lead to symptoms like fatigue, night sweats, and sometimes skin manifestations.
    • Myeloproliferative Disorders: These are a group of conditions that cause the bone marrow to produce too many blood cells, including platelets. They can present with fatigue, night sweats, and skin changes.
  3. Infections:

    • Chronic Infections: Some chronic infections can cause systemic symptoms like fatigue, night sweats, and rashes. These infections can also lead to elevated platelet counts as part of the body's response to infection.

Rash and Body Aches

  1. Dermatologic Conditions:

    • Eczema or Psoriasis: These conditions can cause itchy, red, and bumpy rashes. Stress can exacerbate these conditions, leading to more severe symptoms.
    • Drug Reactions: Although you haven't started new medications recently, it's worth considering if any long-term medications could be contributing to your rash.
  2. Systemic Lupus Erythematosus (SLE):

    • This autoimmune condition can cause a wide range of symptoms, including rashes, fatigue, fever, and body aches. It can also lead to elevated platelet counts in some cases.

What you can do

Fatigue, Night Sweats, and High Platelet Count

  • See a Doctor: Given the combination of your symptoms, it's important to see a healthcare provider for a thorough evaluation. They may perform blood tests, imaging studies, and possibly a bone marrow biopsy to determine the cause of your high platelet count and other symptoms.
  • Manage Stress: Since stress seems to exacerbate your fatigue, consider stress-reduction techniques such as mindfulness, meditation, or yoga.
  • Track Symptoms: Use MDandMe to journal your symptoms, track progress, and share longitudinal medical notes with your provider. This can help in identifying patterns and triggers.

Rash and Body Aches

  • Topical Treatments: Over-the-counter hydrocortisone cream can help reduce itching and inflammation. Moisturizers can also help soothe the skin.
  • Avoid Triggers: Identify and avoid any known triggers for your rash, such as certain fabrics, soaps, or foods.
  • Stay Hydrated: Drink plenty of water to help keep your skin hydrated and support overall health.

What you should look out for

Given the severity and duration of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • New or Worsening Symptoms: If you notice new symptoms such as bruising, bleeding, or significant weight loss.
  • Severe Fatigue: If your fatigue becomes so severe that it interferes with your ability to perform daily activities.
  • Severe Rash: If your rash becomes painful, oozes, or shows signs of infection (such as increased redness, warmth, or pus).

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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4 mo ago

People Also Ask


What could be causing my persistent fatigue and night sweats?

Persistent fatigue and night sweats can be caused by chronic inflammatory conditions like rheumatoid arthritis, hematologic disorders such as essential thrombocythemia, or chronic infections. It's important to consult a healthcare provider for a thorough evaluation.


Could my rash be related to an autoimmune condition?

Yes, your rash could be related to an autoimmune condition such as systemic lupus erythematosus (SLE), which can cause rashes, fatigue, fever, and body aches. A healthcare provider can help determine if an autoimmune condition is present.


How does stress affect conditions like eczema or psoriasis?

Stress can exacerbate conditions like eczema or psoriasis, leading to more severe symptoms. Stress-reduction techniques such as mindfulness, meditation, or yoga may help manage these conditions.


What are the potential causes of a high platelet count?

A high platelet count can be caused by conditions like essential thrombocythemia, myeloproliferative disorders, chronic infections, or chronic inflammatory conditions. A healthcare provider can perform tests to determine the underlying cause.


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