
Suggest Treatment For Cough, Rash And Headaches

Need to confirm the diagnosis.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your symptoms and seen the images.
I agree that these rashes are part of autoimmune diseases, as skin and mucous membrane involvement is common with auto-immune diseases. However, we need to confirm the diagnosis. This would require doing additional tests such as ANA profile, anti dsDNA, serum complement, rheumatoid factor, etc. A biopsy of the skin lesion may also be needed to exclude vasculitis.
At present, it may be better to use high dose steroids, such as methylprednisolone injections for three days.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
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I have had a Mri done of spine and brain but without contrast in 2008 I did have t2 hperintense lesions they said non specific what does this mean ? I also had evoke potentials and I had a slow nerve from brain to leg again they give me no explanation. I have suffered terribly with this illness for over 20 years without medical help . I get great pain and discomfort . I don't have much of a life I spend most my time at home as when the fatigue hits usually around 2 pm is debilitating . The fatigue can happen at any time though . While in flare relapse it's there constantly . Because this is over 20 years I have lived with it.
Vasculitis and MS are more likely.
Detailed Answer:
Thank you for getting back and providing more information. It is unfortunate that you are suffering for more than two decades.
I agree that rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been excluded by appropriate blood tests.
At this stage, we need to consider multiple sclerosis (MS) and vasculitis. The MRI abnormalities and evoked potential abnormalities could fit in with a diagnosis of MS. For further confirmation of MS, lumbar puncture with oligoclonal bands and repeat MRI of brain and spine may be done. If confirmed, interferon injections or one of the newer oral drugs such as fingolimod or dimethylfumarate can give you a much better quality of life, by preventing further relapses.
In view of skin lesions and rashes, we also need to consider vasculitis. In you case, doing a skin biopsy is the simplest method to prove or exclude vasculitis.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


MRI should be repeated.
Detailed Answer:
Thank you for getting back.
Yes, I agree that MRI of brain and spine should be repeated to look for any new lesions.
Also, oligoclonal bands in CSF are not mandatory for a diagnosis of MS. Oligoclonal bands may change in time, they would be present when the disease is active or during a relapse.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

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