Migrating athalgia, malgia and generalized malaisa

[Lalig126]

I am a 20 year old hispanic female and the past 4 months have been a roller coaster ride in and out of ER and doctors and there is still no concrete answer as to what is "wrong" with me. To make a long story short, I have been suffering from migrating arthalgias without inflammation and generalized musculoskeletal pain for the past 2 months or so and I had other symptoms such as abdominal pain and severe headaches. The last time I went to the doctor they did a series of tests including: CBC, electrolyte panel, liver function tests, lipid levels, and also immunology tests (RA factor, ANA, Smooth muscle IgG, ASO titer) to check for autoimmune disorders or other possible causes of the symptoms. Also, they did a chest x-ray to check for TB or any acute process of the lung or see any bony changes and also an x-ray of my wrist (the doctor told me to choose ONE joint that I had been experiencing pain to avoid exposing my entire body to more radiation).

All of the tests came back within normal ranges, the x-rays were unremarkable and showed no acute process or abnormalities, and my RF factor was 10, and ANA was negative and IgG was within the normal range. The only thing that came back high was the ASO titer which was at 600 (normal 0-200). When I returned to my GP he did a throat swab (which I don't know the results) to check for strep throat and said that my symptoms could be due to acute rheumatic fever or post-streptococcal reactive arthritis. He ran tests to determine if there was any heart damage since that is one of the major signs for acute rheumatic fever and said that everything was normal. He prescribed a 10 day antibiotic treatment of Penicillin VK 500 mg BID and referred me to a rheumatologist and I am currently awaiting the approval from my health insurance.

The arthralgias have practically subsided but I have been suffering from generalized muscle ache/pain which is most prominent in my back area, neck, upper buttocks, occipital area, shoulders, arms... BASICALLY EVERYWHERE! I feel as if it could be my tendons, ligaments, not sure...it's just a generalized achy feeling.

I experience abdominal pain when I eat sometimes and I am gassy (im not sure if this has any correlation) but I have a GREAT appetite and no other GI symptoms.


I am really worried! My father passed away from protate CA so I guess I am somewhat traumatized from that experience.

The doctors have reassured me that I am fine and it is just a matter of doing process of elimination but what else could this be? I have thought possibly FM or CFS but I am not sure. Could this be a result of a post-strep infection/rheumatic fever or possibly something else?

I am not requesting a consultation just some guidance or may be advice on what to discuss with my rheumatologist, I will greatly appreciate any input.

Thanks in advance.

ps: my mother has hyperthyroidism, I know that she used to suffer bone pain and generalized malaise before it was Dx but my doc hasn't tested for TSH levels, is this something my rheumatologist can request?

[John Kenyon, CNA]

Hello -

Hopefully by now you've gotten some answers, but for now, let's go with what's here. Your original symptoms certainly were consistent with rheumatic fever, and it was treated appropriately. Since this can sometimes serve as a trigger for FM or reactive arthritis, it is entirely possible this is what's going on now. There is also the potential for some thyroid involvement, at least tangentially, since that gland is often affected by generalized rheumatic inflammation, and the problem also tends to run in families. Your rheumatologist certainly could order a TSH test, if, of course, he is inclined to go that route. It would be interesting to see what, if anything, that were to show.

Meanwhile, I'm afraid the idea of a process of elimination is probably the only realistic approach, along, of course, with appropriate treatment of the symptoms to keep you comfortable until this is either diagnosed or has run its course.

If there is anything new, please update us. Best of luck to you.

[Lalig126]

Thank you so much for your reply, I truly appreciate it.

I am still waiting on that appointment but what mainly worries me are lymph nodes in my neck. After the musculoskeletal symptoms started my tonsils were very sore and swollen, and all other lymph nodes under my jaw line as well. After the penicillin tx they have somewhat reduced in size EXCEPT for the lymph node below my ear (on both sides) is still about 1-1.5 cm and is pretty hard and continues to be painful. Recently Ive been having a sore throat again and the area under my jaw feel tender. ALSO, i've been suffering from tinnitus & ear ache and I feel pea sized lymph nodes behind my right ear.

Could this be caused by the same streptococcal infection?
I believe my GP will perform serial ASO titers when I go to my appt next week but just so I can have an idea because I am terrified of lymphoma/cancer.

I have a hx of ENT problems, asthma, respiratory infections, and had to have an adenoidectomy @ the age of 4 due to recurrent infections so I am really scared.

Thanks in advance.

[John Kenyon, CNA]

Hi again -

You're very welcome!

Well, oddly, for some reason, at least in my experience, those parotid glands that lie in the hollow beneath each ear seem to take a lot longer to normalize after an infection than the others do. I have no idea why this might be, except that there may be some anomaly in the design of the way they drain. At any rate this seems to be a pretty common complaint/concern, but seems to be normal.

Given that you also find enlarged nodes behind one ear and continue to have some ENT symptoms, you may have a stubborn or recurrent infection, and if that's the case it's most likely something holed up in your sinuses, which is where these kinds of bacteria find wonderful hiding places and breeding grounds and sometimes become a chronic annoyance. Your history would argue in favor of this sort of problem, with perhaps some swollen turbinates or polyps having formed somewhere up in the upper nasopharynx, which can contribute to poor sinus drainage and recurrent infections. Sometimes these can be found on thorough examination and removed, with dramatic results. Sometimes the subject just has to deal with each infection as it develops, but there are constantly more and better approaches to treating these problems, so I'd be pretty optimistic about the eventual outcome.

I understand your concerns regarding lymphoma/cancer, but the likelihood of that, given the history, is pretty slim when weighed against the likelihood of chronic sinus drainage problems. Your ENT specialist should know about this concern (if he doesn't already), so he can help put your mind at ease about it.

Good luck to you, and please let us know how your appointment goes.

[Lalig126]

I have been going to an ENT who specializes in ear/throat cases and he had me under observation for 6 weeks to see if he noted any difference in my lymph nodes and after 6 weeks they were practically the same. He says that given my history and because I didn't have any other accompanying symptoms of weight loss he didn't think it was anything bad but rather reactive lymph nodes of a previous infection/chronic infection. I have still been experiencing some right ear pain every so often and have congestion, and my lymph nodes become tender every now and then. BUT to rule out anything bad and because I have been so worried he referred me for a CT of the head/neck with and without contrast. The person performing the CT said that it clearly showed Left Maxillary Sinusitis but that I had to wait for the written report from the radiologist. I have an appt this friday with my ENT for a follow up and results of my CT (crossing fingers), so hopefully everything will be cleared up! I have been super worried all of these months, I hope that you were in fact right, and that this is some kind of infection that's been dwelling in my sinuses. I will keep you updated!

Thanks again for your feedback, I really appreciate it.