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Systemic problem?
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Systemic problem?

I am a 47 year old male with a history of drinking and related digestive problems (diarrhea/malabsorption). Prior to my current symptoms, I had/have experienced frequent diarrhea, a lower back ache, and geographic tongue.  During the past 6 months I have significantly curtailed my drinking to only beer, and no more than a few beers a week.  I take Lipitor, BP meds, and Ambien.

For the last several months, I have been had the following symptoms: Daily sore throat ... worse at night, occasional eye discharge in the mornings, urethritis with frequent/incomplete urination( last 4 weeks), constant stomach "gurgling"', more painful tongue sores with white rings, occasional night sweats, fatigue after a being awake for about 12 hours. Right side lymph node in chin is pea sized, and slightly larger than the left side.  Bowel movements are considerably better with less drinking.  I have lost about 20 lbs, likely attributable to healthier eating/drinking.

I have been treated with Azithromycin, and I am currently in my 3rd week of Doxycycline, yet the symptoms are getting worse.  Blood counts/tests are are normal except slightly elevated liver function.  Hepatitis panel, HIV, and STD tests are all negative.  Gallbladder ultrasound and upper body CT scan negative.   I have been on a gluten free diet for about 4 -5 weeks.

PC, GI, and ENT don't seem to have any further suggestions.  I'd like to press for further testing, but don't know what to ask for.  Any thoughts on potential causes that I can investigate with my PC doctor.

Thank you.



1 Comment
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4610897_tn?1393869202
Hello. Thank you for your question.

In patients who have a large number of symptoms in different organ systems, sometimes there is not a readily apparent unifying diagnosis that ties them all together.

First, one approach is to test symptoms that can be tested for in an objective manner. For instances, urethritis should be tested for with a urinalysis (to test for urinary tract infection) and a urine TMA (urine test for Gonorrhea and Chlamydiae). Lymph node, if it remains persistent can be biopsied.

In addition, general tests for inflammation should also be ordered. These include a white blood cell count (WBC) – which is part of a complete blood count (CBC), and an ESR (sedimentation rate) and CRP (C-Reactive protein should be obtained). Given the weight loss, it is imperative you are up to date on cancer screening, including colon cancer screening with a colonoscopy. If you are anemia (low blood counts) with iron deficiency, an upper endoscopy should also be considered. I agree with HIV testing.

Very Respectfully,
Dr. S
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