Blood tests last summer revealed high titre ANAs (1:2560, 1:5120, 1:640,1:3240, 1:1280 speckled, nucleolar). Two separate follow up labs showed no specificities. I do not meet the criteria for SLE or other autoimmune diseases and thus have not been diagnosed with an autoimmune disorder. I am mildly neutropenic <3.4 (since 2001). I have been diagnosed with Acalculous Cholecystitis unknown etiology--this is being investigated as a separate occurrence. Liver function okay. eGFR-stage 2. Two blood tests in 2006--low anion gap, normal twice since. One lab showed significantly low complements C3 and C4--has not been measured since. Celiac has been eliminated (I've been gluten free since 2002).
I had severe fatigue, shingles, low grade fever, and other disturbing symptoms during this time (last summer and many symptoms of which continue). The fatigue was so severe, that I did not go outside for 45 days and basically stayed in bed. The fatigue is slightly better but I am not at 1/10th what I was at this time last year. I have many bruises on my legs and arms from very slight pressure--but no bleeding issues. I have been having mid back pain (this has never been an issue before).
Studies state that high titre ANAs are the result of an autoimmune disorder, an infection, or malignancy (occasionally they may be seen in the healthy, however obviously this is not my case). There are studies that suggest further tests are in order to rule out malignancy. (Zuber et al, Imran et al, Burnha et al, Tolosa-Vilella et al, Grandics, Tschernatsch for specifics please request).
I have a greater than average risk for lung and breast cancer--however a routine chest x-ray and mammogram last summer were unremarkable.
Primary abdicated authority to Rheumatology and Rheumatology refuses diagnosis, further tests, or referrals.
What further tests should be ordered? And is an oncology referral in order?