Complex presentation

[OMIT00]

33 yr. old F. Completely unable to sit or drive for 3 yrs. As a result of a 6 mnth. repetitive strain injury, dev. muscle spasms, tenderness over entire spine, pain in cervical spine, burning in hands and arms that radiated through face, positional numbness in R shin, severe SIJ pain, sacral edema. Pain eventually radiated from lumbar-sacral area into pelvis and left neuropathy. All pain has a positional compenent. Dx. with Pudendal Neuralgia and TOS. Treated unsuccessfully with steroid and botox injections for 2.5 years. Also hx. of 1-2 episodes of knee inflammation a year (triggered by activity or heat). Two weeks ago used steamroom and then went on walk w/ inclines. Next day knees began to flare, dev. fluid filled inflammation over ankle joints, and the sensation of freezing/burning in entire feet and ankles. Cannot walk for 2 weeks as pressure triggers sx.'s.

Hx., of Mono in 1985, recurrent strep w/ tonsellectomy in 1999, 1998 had acute illness lasting 6 months (swollen glands, fever, photosensitivity, weight loss, malar rash over face, vertigo, fine tremors and sensitivity to heat, dx. with Acute EBV by high blood titers). At the time living in a gutted home under construction. Mother has MS.

All tests, MRI's normal w/ exception of the following. MR Neurography shows inflammation of the pudendal nerve as it descends from the ischial spine up into alcock's canal.

Abnormal echocardiogram consistent with valvular heart disease. Frequent premature contractions throughout the study. Ventricle Bigemy is noted throughout study. Bowing of the mitral valve.  Physiologic mitral regurgitation is noted w/ thickening of the valve.  Aortic regurgitation is noted.  Pulmonic valvular regurgitation. Everything is normal in size.

Streptozyme Titer 200, Microplama pneumoniae .24, DNase-B Antibody 135, CIQ Complement 8.3


  

[Dr. Kokil Mathur]

Hi
Thanks for keeping me posted!
Your heat conditions and your lower leg conditions may not be due to the same cause. Both the causes need to be looked at separately. Lower leg symptoms could also be due to heat/cold allergy (cholinergic urticaria) and also due to abnormal perception of temperature. Your symptom ‘Any pressure or slight changes in temperature triggers severe freezing burning pain in feet’ is like a glove and stocking neuropathy. There are many causes of this nerve disorder including diabetes, hypothyroidism, chronic involvement of liver or kidney, chronic alcohol use, nerve impingement etc.
Hope this helps. It is difficult to comment beyond this at this stage. Do consult your doctor for this.   Please let me know if there is any thing else and do keep me posted. Take care!

[OMIT00]

Thank you Doctornee for your time and suggestions.  A rheumatologist has suggested Rheumatic Fever and prescribed Methylprednisone, Zithromax, and Plaquinel.  Cardiologist dx. Pericarditis.  I am still confused as all sx.'s do not seem to fit into the dx. 1) The pelvic neuropathy and nerve sx.'s in hands w/ radiation into face.  2) The severe sx.'s I am having in my feet/lower legs that have left me completley unable to walk for 13 days.  Any pressure or slight changes in temperature triggers severe freezing burning pain in feet.  If I walk it feels like the tendons are burning and I am walking on burning coals. They seem to be unable to regulate temperature.  Warm shower causes red/purple blotchy color change that subsides.  Do you have any thoughts or ideas on how these would fit into the dx.?  Does the feet also sound like a neuropathy?

Thank you very much : )        

[Dr. Kokil Mathur]

Hi
Thanks for writing to the forum!

I read through your post carefully. Based on it I have some suggestions. This however is being given without examining you, so not sure how far will be able to help you. You should also get yourself investigated for rheumatoid arthritis, rheumatic heart disease with joint involvement (since you have history of tonsillectomy), Vitamin B12 and Vitamin D deficiency. Sine your mother had MS, probably that too should be ruled out.
Hope this helps.  Please let me know if there is any thing else and do keep me posted. Take care!