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Hello, My Son Is 20 Years Old And Has Been
Question: Hello, my son is 20 years old and has been having increased symptoms over the last couple of weeks. Over the last few months, he has lost over 40 pounds, and about 2-3 weeks ago, started developing a fever, chills- but sweats excessively-labored breathing, a sudden need to cough which results in pain in his upper rib area, low blood pressure (has normally been about 115/75-80, but now is 90-100/40-50). He has been to the Emergency Room twice and to his primary dr, and blood tests performed show an increase in WBC, but decrease in RBC. A CT scan and chest xray show course lung markings bilaterally. He is now too weak to walk up any stairs, or even from one room to another. We are becoming increasingly concerned, and cannot understand why he has not been admitted. Would love some guidance. We have hit a wall and cannot get anyone to listen.
Brief Answer:
Some helpful investigations mentioned below
Detailed Answer:
Hello and welcome to Ask a Doctor service,
I carefully read your query and understand your concern,
Weight loss, weakness, and some of his symptoms can be caused by several conditions, and tests are needed to determine the right cause in his case.I would appreciate if you can upload the results of the tests that are already available to you so I can further examine them.
Some tests that would be helpful to investigate the cause of his symptoms would be:
- electrolytes (Na+, K+, Ca++), cortisol, ACTH to check surenal gland function
- TSH and FT4 to check the thyroid function
- fasting glucose to rule out diabetes
- HIV test
- PPD for tuberculosis or Quantiferon test
- he needs a check of his armpits, groin and neck for lymphnodes
- microscopy of peripheral blood sample and ERS
Hope this gives some answers. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
Some helpful investigations mentioned below
Detailed Answer:
Hello and welcome to Ask a Doctor service,
I carefully read your query and understand your concern,
Weight loss, weakness, and some of his symptoms can be caused by several conditions, and tests are needed to determine the right cause in his case.I would appreciate if you can upload the results of the tests that are already available to you so I can further examine them.
Some tests that would be helpful to investigate the cause of his symptoms would be:
- electrolytes (Na+, K+, Ca++), cortisol, ACTH to check surenal gland function
- TSH and FT4 to check the thyroid function
- fasting glucose to rule out diabetes
- HIV test
- PPD for tuberculosis or Quantiferon test
- he needs a check of his armpits, groin and neck for lymphnodes
- microscopy of peripheral blood sample and ERS
Hope this gives some answers. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you-I can attach the portal document showing his test results, along with the info from the ED
Brief Answer:
Detailed answer below
Detailed Answer:
Hello and welcome back,
I am sorry for the late reply,
I carefully checked the uploaded reports.
According to the lung x-ray, there are changes noticed that go with chronic lung disease and a lung doctor is recommended. I do not know if the follow up with the lung doctor was able to happen or not but I think this is a very important consultation to make. It is very important to see what is the specific lung condition behind these findings.
Furthermore, the red blood cells are not too low so it is not worrisome but the white blood cells are quite high which may be an indication of infection. I do not see an ERS check.
He has already checked the electrolytes and they are normal but low sodium. D-Dimer is another index that is high and this is sometimes related to coagulation (clots happening) but is not too specific.
To conclude:
- Probably would be beneficial to take a course of antibiotics (if he did not have some already) as he has a fever and high white blood cells (Azithromycin or Levofloxacine) and if no improvement (normalized fever in 2-3 days) the rest of the checks and examinations mentioned below may be done.
- a check with his lung doctor is necessary- as I saw there was an arrangement for such a consultation
- infection, chronic lung conditions or autoimmune conditions affecting the lungs need to be ruled out- specific tests are needed to determine which is the cause.
- there was mildly reduced sodium, which is a common finding in some lung conditions as well. Because the other electrolytes (potassium) was normal then very likely the surenal glands are normal and nothing to worry about.
I would still recommend the following tests (as I did not find them checked):
- TSH and FT4 to check the thyroid function
- HIV test
- PPD for tuberculosis or Quantiferon test
- he needs a check of his armpits, groin, and neck for lymph nodes
- microscopy of a peripheral blood sample and ERS
- probably adding tests for autoimmune conditions may be needed
- some recreational drugs may also affect the lungs and cause chronic changes especially if taken by smoking so if not sure if he uses such drugs, a urinalysis to rule their use out may be needed.
- in some cases, blood cultures are done in such cases, in hospital setting
These are all the potential causes and possible tests and examinations that I can think of. It is obvious he is having a very unusual presentation and will need proper tests and examinations before the doctors will definitely know the cause of it. Lung biopsy in some cases is the last resort if others do not offer enough answers.
Hope this gives some answers. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
Detailed answer below
Detailed Answer:
Hello and welcome back,
I am sorry for the late reply,
I carefully checked the uploaded reports.
According to the lung x-ray, there are changes noticed that go with chronic lung disease and a lung doctor is recommended. I do not know if the follow up with the lung doctor was able to happen or not but I think this is a very important consultation to make. It is very important to see what is the specific lung condition behind these findings.
Furthermore, the red blood cells are not too low so it is not worrisome but the white blood cells are quite high which may be an indication of infection. I do not see an ERS check.
He has already checked the electrolytes and they are normal but low sodium. D-Dimer is another index that is high and this is sometimes related to coagulation (clots happening) but is not too specific.
To conclude:
- Probably would be beneficial to take a course of antibiotics (if he did not have some already) as he has a fever and high white blood cells (Azithromycin or Levofloxacine) and if no improvement (normalized fever in 2-3 days) the rest of the checks and examinations mentioned below may be done.
- a check with his lung doctor is necessary- as I saw there was an arrangement for such a consultation
- infection, chronic lung conditions or autoimmune conditions affecting the lungs need to be ruled out- specific tests are needed to determine which is the cause.
- there was mildly reduced sodium, which is a common finding in some lung conditions as well. Because the other electrolytes (potassium) was normal then very likely the surenal glands are normal and nothing to worry about.
I would still recommend the following tests (as I did not find them checked):
- TSH and FT4 to check the thyroid function
- HIV test
- PPD for tuberculosis or Quantiferon test
- he needs a check of his armpits, groin, and neck for lymph nodes
- microscopy of a peripheral blood sample and ERS
- probably adding tests for autoimmune conditions may be needed
- some recreational drugs may also affect the lungs and cause chronic changes especially if taken by smoking so if not sure if he uses such drugs, a urinalysis to rule their use out may be needed.
- in some cases, blood cultures are done in such cases, in hospital setting
These are all the potential causes and possible tests and examinations that I can think of. It is obvious he is having a very unusual presentation and will need proper tests and examinations before the doctors will definitely know the cause of it. Lung biopsy in some cases is the last resort if others do not offer enough answers.
Hope this gives some answers. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
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Above answer was peer-reviewed by :
Dr. Prasad
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