Acute CMV or Lymphoma?

I need some advice.  Several weeks ago I went to the doctor after experiencing progressively worsen night sweats for approximately 2 months.  I'm a 33 year old female and my initial thoughts were that I may possibly going through early menopause? My other symptoms include; fatigue, petechaie (legs), low grade fever which gets worse in the afternoons.

My doctor called me the next day after the blood tests and told me to come down to the surgery asap. Within hours, I was having an ultra sound of the abdomine and then the next day I had a CT Scan.  The ultra sound confirmed an enlarged liver & spleen, the CT confirmed the ultra sound plus multipe lymph nodes (mesentary nodes) enlarged.

Other blood tests confirm I do not have any form of hepetitis (hepatitis), or glandular fever, nor HIV. No auto immune.  These are my LFT results; which are higher than the results I had two weeks;

Albumin = 39
AP = 364
GGT = 258
ALT = 143
AST = 97
LDH = 606

I'd be interested in any advice. Thanks Jo

[Mochadelicious]

Hi Jo,
Welcome to our forum.  As you probably already know, the people here are mostly lymphoma patients or caregivers, therefore we can really only give you advice based on our own experiences.

I don't want to scare you, but you seem to be presenting with a lot of symptoms of lymphoma.  Did your doctor mention anything about the possibility of lymphoma?  Night sweats, fevers, enlarged spleen and lymph nodes suggests to me that it might be lymphoma, although there may be other diseases out there that also have simular symptoms that I don't know about.  Your blood levels are also quite elevated.  The only one I'm very familiar with that you listed is the LDH.  Normal levels are supposed to be 91-180.  Elevated levels of LDH can also signify lymphoma.  Can you tell me what ALT and AST stand for?  Did your doctor tell you your levels were high?

I would bet that your doctor will want to do more imaging tests, possibly a PET scan to see if the spleen and enlarged lymph nodes are active for cancer.  He may even want to do a biopsy, which really is the only way to truly diagnose lymphoma.  If he suggests a biopsy, try and have an excissional biopsy (where they take the whole thing out) if you can.  The bigger the sample, the better.  

Take care and please keep us posted.  

[Pickie_1]

Thank you so much for your quick response!

My GP/doctor did say he thought I had Lymphoma, but when he called an haemotolgist at the hospital, he thought I had an infection called CMV and referred me to an infectious diseases specialist.  He said he wouldn't see me until we had ruled out a CMV infection?  The test for CMV is rather subjective, as once you have had the disease (which 50% of people have) you will always test positive (detected) for this virus.

In the last week the glands in my neck have enlarged and don't appear to be going down.  I went back to the infectious diseases clinic on Thursday and the doctor was surprised that my LFT (liver function test) tests had gone up and not down. He's told me to go home and wait another two weeks and he'll repeat my bloods then.

I've looked into LDH and yes you're right, 606 is signifiantly high. I've been given no answers, no drugs, no therapy.  ALT & AST make up some components of the LFT.

[Ken_PA]

Hi, I'd guess here is what happened:

your CBC showed anemia (tiredness) and low platelets (petechiae). The GP found enlarged spleen etc and especially the large nodes - all those signs together can point to lymphoma.

But the hema noticed something on a test, maybe elevated lymphocytes instead of low lymphocytes. So he suspects a virus that can cause marrow suppression, of which there are limited list of suspects. The virus can get into the liver and elevate the liver enzymes etc.

So Cytomegalovirus is the top suspect for now. After other viruses were eliminated.

The ID doc figured you should have been getting over it by now and so was surprised you got worse. Your case is atypical.

While you are waiting for your next tests, and since the infection seems to be spreading, I'd suggest your monitor yourself. Look for increased fever, changes in lymph nodes anywhere, midsection tenderness, a cough, irregular or fast heartbeat.

If something develops then call the ID doc.

As Mocha says, only a biopsy can tell for sure but the very quick spread to your neck nodes strongly suggest some immune reaction rather than lymphoma.

Good luck.

[LynneMargot]

It's so difficult when you know something is wrong but not what!  I hope that you get answers soon. You are on the right track with an ID doctor as well as seeing a hematologist. Please keep us posted on your situation.  Good luck. Sending wishes for your improved health!