Mononucleosis issues?

[cleverpoliwog]

I am a 29 yr. old female, 5'5, 105 lbs.  About 15 wks. ago, I experienced left-sided chest & back pain, relative bradycardia, & shortness of breath.  Went to ER - had chest CT, EKG, blood gases, told everything was fine.  Next couple of days developed fever, extreme nausea, excessive sweating, & tachycardia, & pain continued.  Internist did various blood tests, EKG, echocardiagram - said everything was fine.  Sed. rate normal.  Monospot was negative.  Tested for CMV, HIV,  hepatitis panel, PPD, parvovirus, & EBV.  All negative except for EBV - IgM & IgG titers indicated acute infection.  I was told I'd be over it in 4-6 weeks.  Symptoms all continued unabated. In roughly 5th week following diagnosis, ended up in ER again with left-side chest, back, flank pain.  Chest x-ray, echocardiogram, EKG all "fine."  Blood chem. panel, including sed. rate, normal.  Started to feel somewhat better, but pain continued.  In 8th week of illness low-grade fever (99.6 - my normal is in 97s) returned with continued pain & nausea.  Doctor told me this was in my head & I should take antidepressants.  I changed doctors instead.  In what was about 10th week of illness, new doc did blood chemistry (but not sed. rate) - everything normal except ALT, which was 51.  Ordered chest x-ray, which was normal, & abdominal ultrasound, also normal.  Now in 15th week of illness, I have continued to have pain in left chest (right beneath left breast, occasional random pains above), left upper back around shoulder blade, some occasional radiation into left arm/forearm/wrist.  Pain sometimes seems localized to inside of left ribcage - upper abdominal region; random pains occasionally inside right ribcage. Occasional tachycardia.  Excessive sweating.  Intermittent nausea.  Morning temps around 98.4-6, evening up to 99.6.  Also having some sore throat pain, which I didn't for first 6-8 wks. of illness. Not incredibly fatigued, a tad bit short of breath (but I'm very anxious, & very deconditioned after being ill for so long, so I'm thinking that's causing the dyspnea.) Expressed concern about heart inflammation to new doc - to humor me, she's ordered echo stress, which I'm scheduled to have next week.
My questions are:
1.  Does this sound like mononucleosis?
2.  If so, should I still be having these symptoms 4 months after diagnosis?  Are "relapses" every week or two common?
3.  Is there anything I wasn't tested for that I should be?
4.  I have been concerned about myocarditis.  Is it possible that I have a mild case that wasn't picked up by 3 EKGs, two echos, & two chest x-rays?  Could it have developed since then?  If somehow I have/had it, will the upcoming echo stress test pick it up?
5.  Finally - about 10 yrs. ago, I ended up in ER with what I now think was panic attack.  Doc told me I had mono.  Had no symptoms of illness whatsoever.  Don't know if he ran monospot or was just guessing.  If I had it then, is this mono, or something else?
Thanks,
Rebecca

[Kevin Pho, MD]

1) Acute mononucleosis is a possibility, however it is not common to have the left sided chest pain and shortness of breath.  I would consider other alternatives before settling on a prolonged course of mono.

2) If it is chronic mononucleosis - there are cases where prolonged infection can cause some lung disease.  Unfortunately, there is no proven therapy that has been conclusively studied to treat this.  There is controversy as to whether steroids would benefit.

3) You have already been through a variety of studies already.  I would consider testing for pulmonary embolus - which can also cause chest pain and shortness of breath.  This can be discussed with your personal physician.

4) Myocarditis is normally diagnosed by a biopsy.  MRI and gallium scanning has also been discussed, but has not been proven in clinical studies.  It would be unlikely that the stress echocardiogram would pick up myocarditis.

5) Without examining you, it is difficult to say.  With positive EBV tests, your symptoms can certainly be caused by mono - but I would make sure that other diagnoses are excluded first.

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.

Thanks,
Kevin, M.D.

[chey101]

it sounds like u could be getting panic attacks. sometimes i get them when io'm sleeping and whden i wake up i can't breath, my vision gets blurry, and numerous other things. i usually just sit there and take some deep breathe and try my best to relax myself. try it. it sounds to me you've had enough tests everything keeps coming back normal. u can have pain anywhere without there being anything wrong, maybe it's just that asimple maybe it's just pain and that's it.could u be pregnant?

[cleverpoliwog]

I appreciate your post.  I'm definitely not pregnant.  The panic attack suggestion is a good one - problem is, I'm very well acquainted with those, and they're not my problem right now.  I certainly have some anxiety, but it's due to concern over my symptoms, and it's not at the panic attack level.  It very well could be responsible for my shortness of breath, though.  The pain is of concern to me because it's been present 24/7, in one form or another, for about four months now - that, coupled with just feeling "viral," really has me at my wit's end!  It's very draining.  I had to drop out of law school and need to be able to return in January. I need to feel better!
Thanks very much for your input and concern.

[chey101]

i know the pain can caude u to go crazy. i have had pain in my stomach for 5 months now. first they said it was pid from the iud they put in, but i took the antibotics and i felt better for a couple of days, then they did and ultrasound (after being in pain for 3 months)and found that i have a incomplete ureter obsrtuction, totally unexpected. i went though the pain for 2 more months,and finally the just last week the doctor gave antispasmatic medication to help ease the pain, it's worked but he only gave me a weeks worth. i have been going so crazy! i see the urologist next week (after a 2 month wait!) then tey'll do a scope to find out whats blocking it and then probably surgery. for a while the doc thought it was in my head but after the ultrasound results reasurred me that it wasn't.
maybe u should seek the advice of another doctor.
sorry about all the infomation but it helps ease the frustration of the discomfort to talk (write) about it.
good luck!!

[Dracee322]

Is it not frustrating at the time that lapses when you are being referred to a specialist? I have been through the ringer over the past two years. Like the original post, I too have had all kinds of blood work looking for a reason for my chronic fatigue and VARIOUS other symptoms. EBV came back abnormal with a value indicating "recent primary infection". My doctor was unsure when or if I had mono and basically told me that I could feel this way for up to 5 years or more and there wasn't much I could do. He said I probably have chronic fatigue syndrome and tried prescribing an antidepressant. Up until this point I thought he was a good physician and very thorough. I have lost a lot of respect for him as I feel he started treating me differently when he labeled me with CFS. The problem with a lot of physicians is that they don't think outside of the box. Not all of us have cut and dry symptoms that are easily diagnosed. We are all unique and the make-up of our body's are very individual. I feel like a lot of physicians will throw a label of anxiety, lack of sleep, stress, ect out of frustration because they cannot find a diagnosis and they are too busy with too many patients and making the big bucks and of course pleasing the insurance companies to give quality to their patients. I am in the medical field and I see the anxiety diagnosis thrown out there WAY too often. In my opinion, that is lazy and irresponsible on the part of the medical staff. Of course when someone is not feeling well they are anxious! My six year old son gets anxious when he throws up. Does that mean he has anxiety and not the flu?

[silenthiller4]

Cleverpoliwag, hi there.  Just wanna let you know you are not alone.  I am someone who's been experiencing almost the same syptoms (symptoms) as yours for almost 5 months too.  By the end of July I deep kissed a guy and 6 weeks later I experienced a sore throat, mild fever (~37.3C), fatigue and muscle clamps not due to exercise.   I was tired for like 4 weeks then I recovered.  But for the follwing months since then till now, I've been feeling "viral" off and on, sometimes I feel slightly nauseated, raised body temperature, sweat easily, night sweat, shortness of breath, just general/vague feeling of not feeling well, and there are even several days I had benign positional vertigo, which my doctor told me could be attributed to recent viral infections.  My doctor found no sign of pneumonia, HIV non-reactive, monospot negative.  Basically he can't diagnose me based on my vague/non tell-tale symptoms and just told me I have overreacted/had a HIV scare.  For the first few months I had really overstressed myself and even nowadays there are lingering thoughts of getting a chronic disease or some exotic diseases or something.  But now I am kinda getting used to it and hopefully we'll recuperate eventually.  The facts are there is such thing called the chronic fatigue symdroms, which are what I just described and it's strongly correlated to EBV.  It's differnt from mononucleosis and even if we had mono, just for your info, it's typical for adults to not show pharyngitis as it would normally show in children.  Symptoms for adults are more vague and generalized.