What level of worry is appropriate? (Lymph nodes, fatigue, bloating)

[danfrombefore]

Info: I am a male, in my mid-twenties, no smoking, casual drinking (12 beers a week), history of depression, 5'10 200 lbs, acceptable HR and blood pressure.

Allergic to bees. EBV (mono) when I was a teenager.

Family history: I think my Grandma's mother died of some sort of lymphoma. Dog died of lymphoma too, that was sad.

Meds/Drugs: Adderall XR 30mg morning, 15mg afternoon
                      Vitamin D, Fish Oils daily

Backstory:

March: Came home for Spring Break and had incredible fatigue daily and inability to sleep decently (only melatonin supplements occasionally but didn't help). While I couldn't sleep, I explored my body as one does, and found an enlarged inguinal lymph node (>1.5cm). Over a few weeks, I found one of the other side as well. Both were (and are) around with the persistent inability to sleep. Nodes are firm/rubbery, not sure what is meant by fixed, these are the first lymph nodes I've had that were swollen and I've felt. But I am pretty sure they are fixed.

May: Swollen lymph nodes still there, fatigue still there, now there is bloating and I feel full all the time (even if my stomach says it's hungry, it physically feels filled). Go to doctors, takes blood, normal CBC w/ diff and metabolic panel is clean.

Mid-May: Find a few more, slightly tender, smaller lymph nodes in groin and I have pains in my ribs (cartilage, not bone).

Early June: New CBC w/ Diff and I am still clean and no STD's and Urinalysis is clean. Only test that showed abnormal showed I had EBV in my teens, but it isn't active.

Mid June: All fatigue, sleeplessness, enlarged nodes, pain in ribs, and bloating still here. Now I am feeling around my chest and find that in my supraclavicular node area is pain/what could be swollen nodes. Now I found, 100% certain of, epitrochlear nodes by my elbow are enlarged (>1cm), painless and firm. With these new above the diaphragm enlargements with some being painless I am going to go to the Walk-In soon I think.

So now, should I be worried? Does this warrant further action? Hope I gave enough info! Thanks!

[Ken_PA]

Hi, that's excellently written and all the info helps a lot.

First off, since the 1st node was inguinal, we'd automatically suspect an STD - perhaps not one of the standard ones that have already been tested for.

Next, the enlarged supraclavicular (Virchow's) node usually is very worrisome for cancer except in "generalized lymphadenopathy", and also your younger age lessens particular concern over that node.

Next, the epitrochlear node is large for that node (though it's not easy doing accurate self-measurement). So we could think of lymphoma, except it's much more likely part of your generalized lymphadenopathy.

What makes for overly large nodes (too large to be merely "reactive")? What also makes for nodes that stay enlarged too long? The possibility of a "granulomatous disease" comes to mind.

Neither lymphogranuloma venereum nor granuloma inguinale fit because you have no skin effects. I don't know what other possibilities exist.

If no STD fits, then I'd think of some non-STD infection. Only then I'd think lymphoma, especially since lymphoma rarely makes nodes grow large quickly and then the growth plateaus.

The level of worry? Maybe 6-7 out of 10. The worry is because it is getting worse, spreading. Also there's some small chance over problems that might be created from internal nodes swelling and pressing on something vital.

You haven't had any antibiotics for this?

(Btw, your insomnia is very possibly from immune system chemicals. Consider that Sominex is an anti-histamine.)

[Ken_PA]

...and your Hymenoptera venom allergy is a mast cell thing, and mast cells make histamine,