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- Wed Jul 25, 2007 6:27 pm
First, I'm sorry this is so long! I am a 31 yo female with moderate psoriasis and mild psoriatic arthritis. I took methotrexate for about 2 years, stopped about 4 yrs ago.
I have been having problems with fatigue for about 4 months, started with a week of feeling very dizzy and sick in April. Since then, I have had several episodes where I feel terrible for a few days, run very low fever (around 100) and then get better for a while. In June I had severe back/flank pain. I had a bladder infection and possible kidney infection. I took a 1 week course of antibiotics, pain didn't go away. Had a chest x-ray and ct of abdomen to look for kidney stones. No evidence of any problems on my scan, no stones. Also said no enlarged nodes in abdomen/groin, no problems noticed with spleen or liver. Blood work showed wbc count of about 3000 after course of antibiotics, rest normal, SED rate 7. The pain has come and gone to a lesser degree since.
3 weeks ago I noticed a painless enlarged node in my right neck and saw the NP at my GP's office last week. She said that it was smaller than 1 cm, and felt normal to her. She also thought she could feel a few other smaller ones. She thinks that my scalp psoriasis is causing the enlarged nodes and to come back in 2 weeks. Also did blood work, all said to be normal including wbc, sed rate and liver enzymes. I have found several nodes on both sides since, all seem to be in posterior cervical chain all the way down to the bottom of my neck. Most are very small, but definitely there. I can also feel a small one in my left clavicle. The largest one has not decreased in size at all, not sure if it is bigger (my husband says no).
I have anxiety issues and am extremely afraid of lymphoma as I know that risk is increased for those with autoimmune disorders. I also know that a definitive diagnosis can't be made without biopsy, but I'm wondering what else I should do. The NP said that biospy would only be recommended if the nodes get bigger than 1 cm, is that ok? I called my dermatologists office, and they've never heard of enlarged nodes from psoriasis. Still feeling extremely fatigued, which I know could also be attributed to arthritis and anxiety. At this point, I'm terrified that it might be lymphoma and I am going to be misdiagnosed until it's too late. What should be my next course of action (besides trying to relax lol)? Thank you so much for your time, this is a great service!
| Dr. Chan Lowe
- Fri Aug 03, 2007 7:50 pm
I think your chances of having lymphoma are very low based on what you have described. I suspect it is more likely that the nodes you are feeling are reactive lymph nodes that after being enlarged didn't fully return to their non-detectable size. We call these shotty nodes because they kind of feel like buckshot.
The lymph nodes in the posterior cervical chain very commonly react to viruses.
With your history of prolonged fatigue and ill symptoms you may want to consider being tested for an infection caused by a fungus such as valley fever (coccidiomycosis) or histoblastosis. These two are quite common depending on where you live.