[40F] With multiple systemic symptoms including jaw pain, fatigue, skin changes, and sharp facial pain

Patient Description

A 40-year-old female presents with a constellation of symptoms over the past several months. She reports experiencing restless legs while sleeping for approximately 6 months, significant fatigue and excessive sleeping (up to 18 hours at a time) for 5-6 months, and unusual skin peeling off her feet and hands for 4-5 months. Additionally, she has noticed a yellow tint to her facial skin (not eyes) for the past 3-4 weeks, a swollen and painful left neck gland for 5-7 days, and jaw pain on one side for 8-10 days. The jaw pain is described as a dull, radiating pain that is different from previous TMJ pain and is rated 4-5 on the pain scale. She also experiences sharp, stabbing pain on the opposite side of her face, which she rates as 9-10 on the pain scale, occurring 4-5 times over the past two weeks and lasting 1-4 minutes each time. Other symptoms include raised brown spots on various parts of her body that resemble age spots but are raised and can almost be picked off, tiny black freckles appearing in clusters on parts of her body that don't see the sun, night sweats, heartburn/indigestion, and bowel issues (both diarrhea and constipation). She has also experienced numbness and tingling in her hands, feet, and legs, with occasional sharp radiating pain in her left leg. Recently, she has had trouble reading small text and needs to use her phone to enlarge text. Her medical history includes extremely high cholesterol and triglycerides, treated thyroid conditions due to polycystic ovarian syndrome (PCOS), and a botched hysterectomy last year with subsequent prolapse issues. She takes Sudafed (60 mg a couple of times a week), Allegra (over-the-counter for seasonal allergies), and Ozempic (90 on the syringe once a week). She also takes probiotics and prebiotics. She is allergic to medications in the Imitrex family (causing anaphylactic shock) and bees (for which she has an EpiPen).

Arora's Assessment

What might be happening

It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.

Causes of your jaw pain, swollen gland, and sharp facial pain:

Infection or Inflammation: The swollen gland and jaw pain could be due to an infection or inflammation, such as a dental abscess, sinus infection, or lymphadenitis. The sharp facial pain might be related to nerve irritation or inflammation, such as trigeminal neuralgia.
Lymphoma: Although less common, swollen glands and systemic symptoms like fatigue and night sweats could be indicative of a more serious condition like lymphoma.

Causes of your fatigue and excessive tiredness:

Thyroid Dysfunction: Given your history of thyroid issues, it's possible that your thyroid function is contributing to your fatigue. Thyroid disorders can cause significant fatigue and changes in energy levels.
Chronic Fatigue Syndrome: This condition can cause severe, long-lasting fatigue that doesn't improve with rest and can be accompanied by other symptoms like sleep disturbances and pain.

Causes of your skin issues (peeling skin, yellow tint, raised brown spots, and tiny black freckles):

Nutritional Deficiencies: Peeling skin and changes in skin color can sometimes be related to nutritional deficiencies, such as vitamin B12 or iron deficiency.
Liver Dysfunction: The yellow tint to your face could be a sign of liver dysfunction, even if your eyes are not yellow. Raised brown spots and tiny black freckles could be related to hormonal changes or skin conditions that need further evaluation by a dermatologist.

Causes of your restless legs syndrome:

Restless Legs Syndrome (RLS): This condition can cause an uncontrollable urge to move your legs, usually due to uncomfortable sensations. It often occurs during periods of inactivity, such as when you're trying to sleep.

Unifying Diagnoses:

Autoimmune Conditions: Some autoimmune conditions can cause a wide range of symptoms, including fatigue, skin changes, and swollen glands. Conditions like lupus or Sjogren's syndrome could be considered.
Systemic Infections: A systemic infection could potentially explain multiple symptoms, including fatigue, swollen glands, and skin changes.

What you can do

Jaw Pain, Swollen Gland, and Sharp Facial Pain:

See a doctor as soon as possible: These symptoms could be indicative of an infection or a more serious condition like lymphoma. Your doctor may perform a physical examination, blood tests, and imaging studies to determine the cause.
Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain temporarily. Avoid pressing on the swollen gland as it may worsen the inflammation.

Fatigue and Excessive Tiredness:

Consult your doctor: It's important to rule out thyroid dysfunction or other underlying conditions. Your doctor may order blood tests to check your thyroid function and other relevant markers.
Healthy Lifestyle: Ensure you are getting adequate nutrition, hydration, and regular exercise. Even light physical activity can help improve energy levels.

Skin Issues:

See a dermatologist: A dermatologist can evaluate your skin changes and determine if they are related to nutritional deficiencies, liver dysfunction, or other skin conditions.
Skin Care: Keep your skin moisturized and avoid harsh soaps or chemicals that can further irritate your skin.

Restless Legs Syndrome:

Lifestyle Changes: Regular exercise, stretching, and avoiding caffeine and alcohol can help manage RLS symptoms.
Consult your doctor: Your doctor may recommend medications or other treatments to help manage RLS.

General Tips:

Track Your Symptoms: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
Stay Informed: Educate yourself about your symptoms and potential conditions using reliable sources like the Mayo Clinic website.

What you should look out for

Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Severe or worsening pain: If your pain becomes unbearable or significantly worsens.
Difficulty breathing or swallowing: If you experience any difficulty breathing or swallowing, seek immediate medical attention.
Unexplained weight loss: If you notice significant, unexplained weight loss.
New or worsening symptoms: If you develop new symptoms or if your existing symptoms worsen.

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