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Arthritis (Expert Forum)
Post-viral vs Autoimmune
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Post-viral vs Autoimmune
by kmm, Oct 11, 2004 12:00AM
I am a 31 yr old F and am seeking to figure out whether or not to pursue a rhumetologist appt.
Early Aug. acute onset of joint pain in ankles, knees, hips, wrists, fingers; low grade fever, rash on face, neck, trunk, triceps, and legs, nausea, fatigue, fasciculations all over, dry eyes/mouth upon waking and feeling "out of it". Labored thinking, spacey. Told viral. 10 days post onset of symptoms blood draw for West Nile Virus and Parvo. WNV was positive IgM 4.0 and IgG 1.? Since then, convalescent WNV testing 2x showed IgM decreasing and IgG increasing. Also Parvo was IgM equivical and IgG was 6.? Parvo tested 5 weeks later and showed IgM increased into positive range and IgG increased from 6.? to 7.?
MN Dept. Pub Health confirmed acute WNV and counted as confirmed case
Rash and fever cleared in about a week, nausea 3-4 weeks. During first month: Muscle fasciculations continued and often were worse in right leg, pins and needles sensations throughout body, headaches - one severe on right side with eye pain, generally feeling weak and very tired, anxious
Other tests within the last 3 months: Several CBCs, ANA, sed rate, thyroid, liver fx, brain MRI, EMG/NCS, opthamologist - all normal.
About 3 weeks ago developed tingling/burning in toes and left thumb. Burning in toes worsens and spreads upwards with increased walking/standing, tips of other fingers tingle off and on. Neuro did cervical spine MRI and found some degenerative changes and some disc bulging at C3/C4 and C6/C7. Said the MRI did not show anything that would explain tingling/burning sensation
Currently sx tingling/burning in toes/feet neck/back soreness, marked fatigue, headaches, diffuse hair loss started 1 month post-onset of sx. I take a multi, was taking 500mg B12 until 3-4 weeks ago. Aleve prn
I have a hx of migraines, neck and back soreness/muscle spasms without any intervention other than chiropractor for acute pain. Have had some periods of increased soreness upon waking, but goes away. No swelling/redness of joints. I have had one child with SPROM at 34 wks
Recent hx before illness: May went to Dr. for fatigue, chest soreness - dx costochondritis. Have lost about 10 lbs since May. Change in diet due to son's food allergies to soy and peanut. In past year have eliminated many foods once used to eat such as all nuts, fish, processed foods, all legumes
Neuro has ended his workup Infectious dis. and internal med doc seem to think all sx related to WNV
1.What does this sound like?Post viral syndrome or Autoimmune Disorder or ?
2. Other tests?
3. Does normal CBC rule out B12 def?
4. Sound like periph neuropathy? Can virus cause this? Does it ever improve without treatment? Does it ever go away completely?
5. Assume post-viral and wait it out OR seek Rhem. consult to r/o autoimmune disorder?
6. Have 2 dry/scaly/thickened patches of skin nickel size on ankles for 1 yr - normal color Autoimmune related?
Early Aug. acute onset of joint pain in ankles, knees, hips, wrists, fingers; low grade fever, rash on face, neck, trunk, triceps, and legs, nausea, fatigue, fasciculations all over, dry eyes/mouth upon waking and feeling "out of it". Labored thinking, spacey. Told viral. 10 days post onset of symptoms blood draw for West Nile Virus and Parvo. WNV was positive IgM 4.0 and IgG 1.? Since then, convalescent WNV testing 2x showed IgM decreasing and IgG increasing. Also Parvo was IgM equivical and IgG was 6.? Parvo tested 5 weeks later and showed IgM increased into positive range and IgG increased from 6.? to 7.?
MN Dept. Pub Health confirmed acute WNV and counted as confirmed case
Rash and fever cleared in about a week, nausea 3-4 weeks. During first month: Muscle fasciculations continued and often were worse in right leg, pins and needles sensations throughout body, headaches - one severe on right side with eye pain, generally feeling weak and very tired, anxious
Other tests within the last 3 months: Several CBCs, ANA, sed rate, thyroid, liver fx, brain MRI, EMG/NCS, opthamologist - all normal.
About 3 weeks ago developed tingling/burning in toes and left thumb. Burning in toes worsens and spreads upwards with increased walking/standing, tips of other fingers tingle off and on. Neuro did cervical spine MRI and found some degenerative changes and some disc bulging at C3/C4 and C6/C7. Said the MRI did not show anything that would explain tingling/burning sensation
Currently sx tingling/burning in toes/feet neck/back soreness, marked fatigue, headaches, diffuse hair loss started 1 month post-onset of sx. I take a multi, was taking 500mg B12 until 3-4 weeks ago. Aleve prn
I have a hx of migraines, neck and back soreness/muscle spasms without any intervention other than chiropractor for acute pain. Have had some periods of increased soreness upon waking, but goes away. No swelling/redness of joints. I have had one child with SPROM at 34 wks
Recent hx before illness: May went to Dr. for fatigue, chest soreness - dx costochondritis. Have lost about 10 lbs since May. Change in diet due to son's food allergies to soy and peanut. In past year have eliminated many foods once used to eat such as all nuts, fish, processed foods, all legumes
Neuro has ended his workup Infectious dis. and internal med doc seem to think all sx related to WNV
1.What does this sound like?Post viral syndrome or Autoimmune Disorder or ?
2. Other tests?
3. Does normal CBC rule out B12 def?
4. Sound like periph neuropathy? Can virus cause this? Does it ever improve without treatment? Does it ever go away completely?
5. Assume post-viral and wait it out OR seek Rhem. consult to r/o autoimmune disorder?
6. Have 2 dry/scaly/thickened patches of skin nickel size on ankles for 1 yr - normal color Autoimmune related?
Doctor's Answer
by Kevin Pho, MD, Oct 14, 2004 12:00AM
, Oct 14, 2004 12:00AM
To answer your questions:
1) Certainly either consideration is possible - however with the extensive workup you have had, it would make an autoimmune disorder less likely.
2) You have had a pretty comprehensive evaluation already - there are no further tests that I can think of. At this time, I would consider a rheumatology evaluation.
3) I would check a blood level of vitamin B12 - that would be the best way to rule out deficiency.
4) The answer would depend on what the cause of the symptoms were. There may be some causes of peripheral neuropathy that may improve over time - but this is tough to answer without knowing the cause.
5) I would consider the rheumatological consult.
6) Yes, it is possible that the skin lesions can be caused by a rheumatological disease. Things like lupus can certainly cause the skin findings.
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.
Medical Weblog:
kevinmd_b
1) Certainly either consideration is possible - however with the extensive workup you have had, it would make an autoimmune disorder less likely.
2) You have had a pretty comprehensive evaluation already - there are no further tests that I can think of. At this time, I would consider a rheumatology evaluation.
3) I would check a blood level of vitamin B12 - that would be the best way to rule out deficiency.
4) The answer would depend on what the cause of the symptoms were. There may be some causes of peripheral neuropathy that may improve over time - but this is tough to answer without knowing the cause.
5) I would consider the rheumatological consult.
6) Yes, it is possible that the skin lesions can be caused by a rheumatological disease. Things like lupus can certainly cause the skin findings.
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.
Medical Weblog:
kevinmd_b
Good Luck and God Bless!
S.B.