What could this be?

I am a 38 yr old female.  In Nov '05 I experienced the first fainting experience of my life. As I went down I hit my sternum on a sharp corner of my bathtub. The next day my sternum was extremely sore and I began to have breathing problems.  I had an x-ray done that showed no fracture or problems with my lungs.  Two days later I went to the emergency room with the following symptoms: chest pain (left side); pain when exhaling or inhaling deeply; elevated heart rate; lump in my throat; terrible bloated feeling in abdomen and extreme tenderness to pressure in all quadrants; tingling on my left side (face, shoulder blade, arm and hand); burning and tingling in my spine; facial twitching; enlarged liver and spleen; and, strong smelling, dark urine. An X-ray of my spine was normal.  Routine blood tests were normal (don't know what exactly was done, except for SED rate, liver function, thyroid).  A CT scan of my abdomen was normal. I was told i had GERD and the rest was stress.  Today I no longer have the lump in the throat, the chest pain, the breathing issues, or an enlarged spleen.  I still have the tingling in my face, arms and hands, but now it is on both sides (although only on one side at a time)and occasional facial twitching.  I have also begun to experience tingling and pain all over my body. I still have burning and tingling in my spine and sometimes if I touch one of my vertebra I can feel the pain in that exact spot for at least another 30 minutes.  Off and on I have swollen lymphs all over, especially noticeable in my left forearm.  My palms are now often blue and often the arteries in my forehead, around my eyes and in my arms are raised and visible (even when my BP is normal). While my urine is no longer dark or strong-smelling, I noticed that it has the appearance of oil floating in it; I am extremely tired all of them time and have trouble concentrating.
My eyes are now sensitive to sunlight.  A test for ANAs did come back positive.  I am also positive for Epstein Barr and CMV. Could you tell me what all of this might indicate and what other tests I should be having done?  I can track to an exact day when all of this began (on that day I received very stressful news the substance of which has not been resolved--thus, ongoing stress for me). Is it possible that stress alone can cause an auto-immune reaction?  Is it possible that i have had some underlying auto-immune condition that only significantly manifested itself upon severe stress? I used to take phentermine  for weight loss...could that be related? What about other stimulants--I often have to work for more than 48 hours straight and have tried just about everything to stay awake and focused during those times--could they have contributed to this?  Also, what tests should I consider having done to figure this all out?  Thanks

[Kevin Pho, MD]

Tough to say without examination.  With a positive ANA - it would depend on the strength of the titer.  Note that healthy individuals can have positive ANAs as well.  I would consider testing specific autoantibodies - such as ds-DNA and Sm antibodies looking for lupus.  

It may be possible that stress can trigger a previously undiagnosed autoimmune disease.

Although possible, I am not aware of the symptoms being associated with previous phenteramine use.  

Regarding the fainting episode, I would consider a more thorough cardiac workup.  This can include a stress-echo to evaluate the structure of the heart as well as any blockages in the coronary arteries.  A Holter monitor or event monitor can look for any arrhythmias that may be contributing to your symptoms.

I would discuss these options with your personal physician - or consider a rheumatology referral to evaluate the positive ANA level.

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_b

[myproblem]

ANA indicates Lupus, but before you worry too much about that, keep in mind that positive ANA is not uncommon in the general population, and alone does not prove an autoimmune disease. I want to answer more of your questions, but don't have time tonight. I'll try to port again tomorrow. In the meantime, read all relevant information at this link. http://www.cdc.gov/ncidod/diseases/cmv.htm

[myproblem]

Also, read the Dr. response to post
Q: Positive ANA - Rio04: 02/09/2006

[kittykitty]

Ahhhhhh..... I have had nearly all of those same issues at some point and still no diagnosis except for Chronic Fatigue (this from CMV, EBV and HHV6).  I am ANA+ with high at 1:1280 but the numbers more typically 1:640 the pattern went from speckled to homogeneous.  Veins can pop out on face, hands are swollen and veins are huge....hands turn red, blue, white from Raynaulds.  Had that feeling of having a heart attack too, lump in throat, lymph nodes that hurt, swollen and severe pain and swollen veins in forearms, carpal tunnel symptoms, dizziness, SEVERE fatigue, cognitive dysfunction, disgusting acne-like rash on face, chest, back, bottom, another rash on hands and fingers (little blisters), severe spells of muscle weakness especially in legs that make it feel like you'll fall (done twice holding kids).  Agghhhhh!  Every single day it's something new.  UCTD is the closest that anyone is willing to say at this point although I suspect Lupus may be my destination.  My symptoms also began at the onset of a severely stressful time and I have heard that this is indeed common.  Phenteremine is still taken -- only thing that will keep me functioning and out of bed.  Do you happen to have implants?  I had mine removed and while my symptoms persist my ANA went down substantially.  There is still much debate on any correlation but this was my experience.  Have your Rheumy do a FULL lab work up looking for antibodies.  They found HLA B27 marker for me but does not seem to fit into my clinical picture.  Watch and wait seems to be how this is treated.  I was placed on Enbrel and had a horrible reaction so do be careful about starting drug therapies.