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- Wed Aug 04, 2010 5:32 pm
Hello doc i am 29 year old female married for 11 months, 4 months bk i got my bartholyn cyst removed then i flew to Sydney and had lot of pelvic pain and was eventually got diagnosed with cin 1 and chronic dvt in left leg ,at present i am off wafrin as clot has resolved but still have pain in left leg and specially femoral area .when i got diagnosed with cin 1 i was under lot of stress and felt as if my neck would choke and felt heaviness of left side of chest with frequent chest pain,lung scan was done for it it was alright. for choking i was told that it is because of stress so i didn't pay much attention but recently it got worse i got ultrasound done and it showed multiple lymph nodes biggest is 1.5 cm in neck . i am on antibiotics right now and am asked to get chest x ray done, i am worried i may have few lymph nodes in pelvic region also .what do u think it could be what should be my course of treatment ? please help
| Dr.M.Aroon kamath
- Thu Aug 05, 2010 10:53 pm
It is indeed unfortunate for you to develop a DVT such a young age. Did the doctors find any underlying predisposing factors-congenital thrombophilias, for example?
You indicate that you have cervical intraepithelial neoplasia type 1 (CIN 1) and few palpable cervical and pelvic lymph nodes. You have not mentioned which group of lymph nodes in your neck are enlarged.That might have helped.
DVT, CIN-1 and enlarged cervical and pelvic lymph nodes could well be completely unrelated, isolated entities or could have a common background.
CIN-1 is a low grade squamous intraepithelial lesion and not a "cancer" as such. Neither the pelvic lymph nodes nor the cervical lymph nodes are likely to be directly caused by the CIN 1. CIN 1 has been shown to have a high rate of spontaneous regression within 1 year. For cervical lymphadenopathy, the list of causative factors is exhaustive.
Some risk factors have been identified and found to be important in developing CIN. Two significant ones among them are,
- Women who are immunodeficient and
- infection caused by the higher risk serotypes of HPV, such as 16, 18, 31 or 45.
Women with HIV are 10 times more likely to develop CIN. Risk of CIN is increased in HIV positive women by
- decreased CD4 cells and
- associated Human papilloma virus (HPV) infection.
(HIV infection is thought to activate the HPV and cause cellular abnormalities).The CIN tends to progress more rapidly and is also resistant to conventional treatment.
Toxaplasmosis is a well known cause of cervical lymphadenopathy. Immunocompromised individuals are at a higher risk. Most acute Toxoplasma infections are relatively asymptomatic. Lymphomas have been reported with toxaplama infections.
The reported incidence of venous thromboembolism (VTE) in patients with HIV infection has ranged from 0.25 to 0.96% in clinical studies, but up to 17% in autopsies.The overall risk of DVTDVT in HIV/AIDS appears to be approximately 2-10 times greater than in the general population.The underlying mechanisms behind this hypercoagulable state are being investigated extensively.
As i pointed out earlier,all of your symptoms and signs (DVT, CIN-1 and enlarged cervical and pelvic lymph nodes) can very well be completely unconnected and in that case, cause for each must be sought independently. However, it is safer to have your HIV serostatus confirmed.