Just to catalogue my symptoms so far:
-lethargy, malaise and ?depression - about 3 months
-pain in both calves - 14 days ago, for 3 days, resolving spontaneously
-generalised myopathy and ?rigors- 10 days ago, for about 3 days, resolving spontaneously
-leucopenia (neutrophils 1.6, lymphocytes 0.60); Hb 13, but i'm on a multivitamin with iron in it
-raised d-dimers (exact level not known to me)
-morbiliform rash all over body, including palms, soles and face, with mild bilateral conjunctivitis - 7 days ago, for about 3 days, resolving spontaneously (slightly itchy, resolving with cetirizine)
-lymphadenopathy, mainly cervical (smooth mobile nodes about 2cm) - last 7 days
-pain, stiffness and swelling in joints - small joints of hands and feet, both ankles, both wrists and both knees. stiffness for about an hour in the mornings, difficulty walking and turning doorknobs - last 3 days, worst today
Differential diagnosis:
1. viral infection - possible viruses include parvovirus B19, EBV (common, fits all symptoms and I am at risk due to occupational exposure to lots of children)
2. rheumatoid arthritis (but is not associated with rash, also peak age of onset = 5th decade); or other connective tissue disease
3. hypothyroidism (also not associated with rash, but could explain all other symptoms and is commoner in females)
4. lymphoma (unlikely due to leucopenia and normal blood film, but peak age of incidence =3rd decade)
Therefore if the symptoms continue after next week, I suppose I should get someone to take blood from me for
-repeat FBC and film, U&Es. LFTs, TFTs, ESR, CRP, ANA. antidsDNA and rheumatoid factor
The question is how soon to do them. Maybe I'll give it 4 to 6 weeks.
Meanwhile I shall be taking ibuprofen regularly.
The GP didn't do much for me apart from providing a sick note. I had hoped he would at least examine my joints, but he didn't seem interested. He also didn't seem to know that parvovirus infection can cause raised autoantibodies and ESR (and therefore those tests would be completely useless at distinguishing between 1. and 2. at this point). I think I might feel better if I could just stop being (my own) doctor for 30 minutes.
Friday, May 04, 2007
diagnosis? (or, I'm not feeling so good)
Posted by cirrus29 at 9:26 pm
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