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- Fri Mar 30, 2007 2:28 pm
I am a 41 year old, very fit male residing in Wyoming. In January of this year I began to experience testicular swelling (rt side only) and associated pain. The urologist concluded epidemyitits and prescribed antibiotics. Within a couple of weeks, the swelling did not resolve and an ultra sound was ordered. The test was negative as far as testicular mass but positive for for a hernia. Two years ago, I had bilateral hernia repair. So, back to the surgeon I go. The surgeon orders an abdominal and pelvic ct which was normal other than some degenerative back issues in the lumbar area . The surgoen does not believe that there is a hernia. The testicular swelling has since disappeared but the pain has not. For the last month, the lymph nodes on my right side, specifically, the superficial subinguinal glands are swelling and continuing to grow, The largest is about 5 cm and another is 3 cm. They are painless, not moveable and have a rubbery texture, but are not hard. My Gp ran a CBC (with diff) last week that showed elevated AST and ALT, but the blood counts were within normal limits. A subsequent hepatitis test was negative. At the beginiing of the week, I began developing bruising (about the size of a checkbook) on the inside of both thighs with the bruise on the right side being much darker and defined. I have had no trauma in this area whatsoever (or on the legs or feet). For the last several months, I have experienced drenching night sweats at least once a week (sometimes more often). I have not had a cold or respiratory infection for six months or better. In the last 30 days, I have experienced groin pain (feels like tugging) and pain in the right flank, both right above the hip and below the rib cage. The testicular pain continues but is intermittant. I am fatigued and tired, although I am very active physically so fatigue is not all that uncommon for me. I have not had multiple sex partners for at least three years (I am newly married) and a s a result, STD seems highly unlikely. An internet search with these symptons identifies lymphoma and leukemia as possibilities, but with the normal blood counts, doesn't this rule out these conditions? The physicains here are stumped and any assistance you could offer would be most appreciated. Right now, the advice is to wait three weeks and see if there is improvement, call immediately if the symptoms are worse and come back if they stay the same. I have also been advised to stay off any pain medication whatsoever as well as other items that may elevate the liver enzymes. What are your thoughts and where do I go from here. Do the blood tests rule out leukemia and lymphoma?
| Dr. Chan Lowe
- Mon Apr 02, 2007 11:23 pm
Your symptoms are interesting. Initially, they are quite consistent with an epididymitis or orchitis (inflammation of the testis). Viruses are well known to cause these issues (more so with orchitis than epididymitis) so this may explain why the antibiotics did not help. A viral infection may also explain the elevated liver enzymes.
A normal CBC does not rule out lymphoma or leukemia but it does make it much less likely. Often, by the time symptoms begin to appear the bone marrow is affected sufficiently to cause changes in the CBC.
It is difficult to tie the bruising together with the scrotum pain. The flank pain may be an indication of a kidney stone. A CT scan of the abdomen is the most sensitive test for this.
One other uncommon possibility (and you would have an atypical presentation if it is this) is a vasculitis that could tie all your symptoms together. I cannot think of a specific vasculitis that could explain all your symptoms.
I hope this helps a little. I would recommend you continue to follow up with your urologist and primary care physician.