Immune system and neurological problems

I am female, late 30s. Here is some history:
- three years ago dx with Trigeminal neuralgia and developed pins and needles left side. MRI showed large lesion in right lobe. Follow up confirmed 3 lesions in this area - told demyelination, and Probable MS, then told maybe not when EPs were clear
- Took Carbamazepine for pain then changed to Gabapentin 1 1/2 yrs ago
- 2 years ago had recurrent pneumonia and dx Bronchiectasis, also 4mm pulmonary nodule which has been stable for 2 years
- severe chest pain where pneumonia occurred and through lower breatbone when I get infections/fever, hence rheumatological work-up
- Bloodwork for rheumatology has all been clear including ANAs
- no joint pain, no depression/stress etc.
- I exercise regularly, eat well
- left side leg now is cramping, occasional coordination problem left hand, shocks down spine and through arms
- IGg consistently low, history since childhood of infection, IGg 1, 2, 3, 4 have been normal though so far in spite of low IGg. IGM and E and A were fine.
- recurring daily fever, and currently on antibiotic therapy to maintain functioning.
This is very confusing to me and doctors because it looks a little bit like various conditions but not completely like any of them - MS?, Lupus? Primary immune deficiency?  I am fatigued and catch infections easily which start up neurological symptoms.
Question: Where do I go from here? I'm not sure what even has been ruled out/in or what needs still to be examined in order to stay well.

[Kevin Pho, MD]

It is true that the symptoms and lab results are not specific to any one disease.  

The diagnosis of MS can be further evaluated with a lumbar puncture and analysis of the CSF for oligoclonal bands.  

Lupus can be evaluated with the ANA - if negative, it would be less likely that this disease is present.

As for immune disorders, common variable immunodeficiency can be considered - however appropriate testing with immunoglobulins has been done.  

You can consider a neurology referral to further evaluate the pins and needles.  Electrodiagnostic testing like an EMG can be considered.  A second opinion with a neurologist can also be considered - preferably at a major academic medical center.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[PlateletGal]

You may want to consider seeing a physician who is familiar with fibromyalgia and CFS. CFS affects your immune, nervous and endocrine system.