
Suggest Treatment For Swollen Lymph Nodes On Neck Along With Fatigue

Tissue biopsy alone gives definitive diagnosis
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
Read and re-read carefully to understand the sequence of events and tried to correlate all.
My thoughts and opinions with explanation:
This is a 21 year old problem.
Started as enlarged lymph nodes in the neck, fatigued and sick. EBV positive in blood - but n FNAC or biopsy done.
False positive TB - might have been true TB as the findings are seen later as calcified lymph nodes (most suggestive of old healed TB).
Then stabbing chest pain, worsening with breath - mostly suggestive of pleurisy (can be due to TB as one of the reasons) or costochondritis and so on.
LN biopsy planned but unfortunately not done.
(Body takes care of all the infection and only when the resistance is low or when the body mechanism can not cope the signs and symptoms are exhibited.)
Chest pain every 5 years, learned to cope with.
Now you are 39 - pains, fatigue and constant back pain; X-ray, CT and other tests show damage to the lung and calcified lymph nodes hence referred to the Pulmonologist.
Alcohol causes severe abdominal cramps within minutes - suggestive of severe gastritis or intolerance.
Also have constant back pain and restless leg. White of the eye turning into yellow and is blood shot.
All these symptoms and their explanation still leads me to the cause as some granulomatous disease and need further investigations.
The biopsy of the diseased tissue is the only sure-shot way for a perfect diagnosis, rest of the investigations and clinical evaluation add to the clinical diagnosis and is driven by rule of high degree of suspicion.
I am hopeful that the Pulmonologist and/or any other specialist would definitely lead to a proper diagnosis by tissue biopsy.
I would advise in addition the following:
MRI of the spine at the painful area.
Blood tests for specific disorders like Quantiferon gold test for TB and the others that you should request for.
I hope this answer and explanation helps you for early diagnosis and treatment.


Biopsy is a must.
Detailed Answer:
Thanks for your feedback, additional information and the picture.
I think you should go for lymph node biopsies to get to the core of the disease.
Please consult a General Surgeon and insist on FNAC of all the nodes you have and the excision biopsy of the most suspicious lymph node.
R-rays do help as a screening tests and only CT scan show the better details, hence the normal looking X-ray is not the guarantee that everything is fine. This is the reason CT scan is more important and you have already got one done with the findings.
Can you please post the report of the CT scan of the chest?
Please feel free to discuss till you are satisfied.


Other reports please, if you can.
Detailed Answer:
Thanks for the reports.
The levels in some of the reports are on the borderline, even D dimer is just elevated hence not significant.
What about the CT scan of the lung report?


Granulomatous disease noted.
Detailed Answer:
Chronic lung condition - prior granulomatous disease is indicated in the CT scan reports.
Let us see what your Pulmonologist has to say.
Please give feedback .

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