[42F] With persistent fatigue, LUQ pain, and lymphadenopathy

Patient Description

A 42-year-old female has been experiencing severe fatigue and left upper quadrant (LUQ) abdominal pain since July, along with back pain and shortness of breath. The fatigue is constant and does not improve with sleep, significantly affecting daily activities and quality of life. The patient reports swollen lymph nodes for the past five months, which are not painful but sometimes make the skin sore. An ultrasound showed several lymph nodes in the neck and supraclavicular area, and the patient can feel them in the armpits as well. The patient experiences episodes of low-grade fevers, clammy skin, and night sweats, sometimes accompanied by chills. Recently, a rash appeared on the neck that itches and stings. The LUQ pain is described as stabbing and occurs several times a day, while the back pain is a constant dull ache in the lower back and a burning, stabbing pain between the shoulder blades, causing shortness of breath. There have been significant weight changes, initially losing about 25 pounds without trying, followed by weight gain due to bloating. The patient's appetite is low, but there are new sugar cravings. Bowel movements are regular, and no specific foods worsen the bloating. Medical history includes elevated white blood cells, platelets, calcium, and eosinophils, with a high sedimentation rate but a negative ANA test. The patient also has an enlarged spleen. There is a family history of lymphoma, prostate cancer, liver cancer, leukemia, and brain tumors. Current medications include Estradiol and Lisinopril, and the patient's A1c level is 5.7, indicating they are not considered diabetic anymore.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've shared, there are a few potential explanations for what you might be experiencing:

  1. Lymphoma or another type of blood cancer: Given your family history of lymphoma and the presence of swollen lymph nodes, weight loss, night sweats, and fatigue, it's important to consider the possibility of a blood cancer. These symptoms are concerning and warrant further investigation by a healthcare professional. Typical testing might include blood tests, imaging studies like a CT or PET scan, and possibly a biopsy of the lymph nodes.

  2. Infection or inflammatory condition: Elevated white blood cells and eosinophils can sometimes indicate an infection or an inflammatory condition. However, given the chronic nature of your symptoms and the presence of an enlarged spleen, this is less likely to be the sole cause.

  3. Autoimmune disorder: Although your ANA test was negative, some autoimmune disorders can present with similar symptoms, including fatigue, swollen lymph nodes, and skin rashes. Further testing might be needed to explore this possibility.

What you can do

Swollen lymph nodes and fatigue: It's crucial to see a healthcare provider as soon as possible to evaluate these symptoms further. They may recommend additional tests to determine the underlying cause. In the meantime, try to:

  • Rest as much as possible and prioritize sleep.
  • Maintain a balanced diet to support your immune system.
  • Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

LUQ pain and back pain: While waiting for a medical evaluation, you can:

  • Apply a warm compress to the affected areas to help alleviate pain.
  • Consider over-the-counter pain relief, such as acetaminophen, if approved by your doctor.
  • Avoid activities that exacerbate the pain.

Night sweats and skin rash: To manage these symptoms:

  • Keep your bedroom cool and wear breathable fabrics to bed.
  • Use a gentle, fragrance-free moisturizer on your skin to help with itching.
  • Avoid hot showers, which can worsen skin irritation.

What you should look out for

Given the potential seriousness of your symptoms, it's important to seek medical care promptly. Be vigilant for any of the following:

  • Rapidly enlarging lymph nodes or new areas of swelling.
  • Persistent or worsening fevers.
  • Unexplained bruising or bleeding.
  • Severe shortness of breath or chest pain.

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

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1 mo ago

People Also Ask


What could be causing my severe fatigue and swollen lymph nodes?

Severe fatigue and swollen lymph nodes can be caused by several conditions, including infections, autoimmune disorders, or blood cancers like lymphoma. It's important to consult a healthcare provider for a thorough evaluation and appropriate testing to determine the underlying cause.


How can I manage my LUQ abdominal pain and back pain at home?

To manage LUQ abdominal pain and back pain at home, you can apply a warm compress to the affected areas, use over-the-counter pain relief like acetaminophen (if approved by your doctor), and avoid activities that worsen the pain. However, it's crucial to seek medical advice for a proper diagnosis.


What might be the reason for my night sweats and skin rash?

Night sweats and skin rashes can be symptoms of various conditions, including infections, autoimmune disorders, or even certain types of cancer. Keeping your bedroom cool, wearing breathable fabrics, and using gentle moisturizers can help manage these symptoms, but a healthcare provider should evaluate them further.


Should I be concerned about my family history of cancer given my current symptoms?

Given your family history of lymphoma and other cancers, it's important to be vigilant about your symptoms and seek medical evaluation. Your symptoms, such as swollen lymph nodes, weight changes, and night sweats, could be indicative of a serious condition that requires prompt attention.


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