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Forum Name: Lymphoma

Question: lymphoma or mono


 wlane11 - Wed Jan 03, 2007 12:54 pm

37 y/o male.
Hepatitis profile negative.
Spleen moderately enlarged. Density normal. (CT)
Heterophile, presumtive 1:56
ANA Screen: Negative
HIV: Negative
Seq Neut # Low
Lymphocyte Ab # high
Monocyte Ab # high
Eosinophil Ab # normal
Basophil Ab # normal
sed rate: high 16mm/hr
TSH: normal
iron: low
LDH: very high 379 u/l
Na, K, Cl : low
bun/create Low
albumin: low
ast: high
alt:high
CBC: normal

fever long term, night sweats, eyelid edema, fatigue.
Amoxicillin for sinusitus.
Mo

Diagnosis?
 Dr. Chan Lowe - Wed Jan 03, 2007 2:45 pm

User avatar Are you able to provide us with actual numbers for your lab tests? Unfortunately, with most tests high may mean a little high or a lot high. Also, do you know your WBC count at the time the neutrophils, etc. were done.

Just based on these labs, a diagnosis of mono or lymphoma cannot be made. Mononucleosis typically is an infection of teenage and early twenties; however, this does not rule it out.

To diagnose mono, one should have a monospot test done. If it is negative, it almost certainly is not mono.

Your ESR is not actually that high. Most inflammatory states will push ESR's higher than that.

Let us know a few more details if you are able and we may be of more help. Also, how long is long term for your fever? Have your symptoms been getting any better?

Thanks.
 wlane11 - Wed Jan 03, 2007 7:21 pm

Thanks - yes, here are the details.
Fever for about 5 weeks. Peaked at about 103 for about a week. Has subsided recently. If I have a fever now I think it is very minimal. I have extreme fatigue. Sleep all the time. The fatigue is not getting better. I had a cough for a while but that is now better. I also had eyelid itching, so bad I saw an opthamologist. I noticed this as a symptom for mono in the merck manual. Here are the numbers and more detail:

Spleen is moderately enlarged extending well below the margins of the ribs. All other organs normal.

Heterophile, presumtive: 1:56 rnge < 1:56
Seq Neutr %: 12.0 rnge 40-70
Lymphocyte %: 60 rnge 22-36
Monocyte %: 12.0 rnge 0.0-7.3
Eosinophil %: 2.0 rnge 0.0-4.5
Basophil %: 2.0 rnge 0.0-1.8
Band %: 12.0 rnge 0-10
Seq Neut Nbr: 1.1 rnge 1.8-7.7
Lymphocyte Ab #: 5.3 rnge 1.0-4.0
Monocyte Ab #: 1.1 rnge 0.0-0.8
Eosinophil Ab #: 0.2 rnge 0.0-0.5
Basophil Ab#: 0.2 rnge 0.0-0.2
sed rate: 16 rnge 0-15
TSH: 1.59 rnge 0.49-4.67
Iron Binding Profile:
Transferrin: 234 rnge 180-329
Iron: 49 rnge 49-181
ironbindingcap ttl: 328 rnge 250-450
% saturation, iron: 15 rnge 20-55
***
LDH: 379 rnge 91-180
***
glucose 108 rnge 75-100
BUN 3 rnge 9-20
creatinine: 1.0 rnge 0.8-1.5
sodium: 136 rnge 137-145
potassium: 3.0 rnge 3.6-5.0
chloride: 99 rnge 98-107
co2: 28 rnge 22-30
bun_creat ratio: 3.0 rnge 7.0-25.0
anion gap: 12
calcium: 8.6 rnge 8.4-10.2
tot protein: 6.3 rnge 6.3-8.2
albumin: 3.2 rnge 3.9-5.0
alb_glob ratio: 1.0 rnge 1.5-2.5
ast: 50 rnge 5-40
ala aminotrnsfrse: 73 rnge 7-56
CBC with differential -- All numbers are right down the middle.
 Dr. Chan Lowe - Thu Jan 04, 2007 2:52 pm

User avatar It appears from your lab results that your monospot (heterophilic antibodies) is positive. If I am interpreting this lab correctly a normal test would be less than 1:56 and your was 1:56. This would be considered positive although weakly.

The rest of your labs are essentially normal. Just based on this, I would say that you have mononucleosis. Your symptoms fit and you have a positive monospot. Lymphoma is unlikely, although lymphoma can "hide".

I suggest you follow up with your doctor. Please do not take this as a formal medical consultation as I cannot directly examine you.

Hope this helps.
 wlane11 - Sat Jan 06, 2007 7:57 pm

Thanks -

My Hematologist says his gut feeling is that I have a virus. The CT of the spleen shows no lesions and no other symptoms of lymphoma. More blood work for EBV and cytomeg virus. Maybe another CT in 2 months.

I feel like hell, but I guess it could be worse.

Thanks for the help....

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