Enlarged spleen - tests good so far

[Belial1134]

About 8 or 9 days ago I was experiencing pain on my left side which then moved about the whole abdominal area. Finally got blood work done last week and everything came back good. Doctor had me get a ct scan which was good other than an enlarged spleen (14cm)

Today I had a chest X-ray (negative) and more blood drawn (8 tests in all). I've gotten 3 back and so far everything was good on those. I'm meeting with the oncologist/hematologist on Thursday though my anxiety isn't helping at all.

I turn 40 this year. About 5ft 8 and 173 pounds. Last year I had a bout with LPR (silent reflux) but I got over that in mid October. Not sure if this could in any way be related though.

With all the possibilities of what can cause an enlarged spleen, Im worried. Guess I'm looking for others who had similar issues but had good news when all was said and done?

Thank you for reading

[mkh9]

Hi, I am not a doctor but I am a microbiologist and can try to give you advise.

Your spleen is like lymph nodes, it swells up when you have an infection. One thing it swells up with is mono or Epstein Barr virus. Do you have any other symptoms? Parasitic infection such as toxoplasmosis that you get from dogs and cats can make your spleen enlarge, Some bacterial infections, Rheumatoid arthritis, injury during contact sports, a cyst (but they would have seen that on the ct) and then there are the scary things like leukemia and lymphoma.

Have you had a complete blood count? If so was it normal? So if normal then it probably isn't leukemia or lymphoma. You would normally see this on the blood test. The lymphocytes would be very high or platelet count low for lymphoma and for leukemia the white blood cells also specifically the PMN's (neutrophils) would be really really high, like 20,000. Also they would see abnormal cells with leukemia. So you may have an infection of some type. Do you have any other lymph nodes that are swollen?

No silent reflux (I have it too) doesn't do this.

This is just an opinion but just thought I would say what I thought.

mkh9

[Belial1134]

Hi,
Thanks for the reply. I've started to get results back.
I've had 2 CBC w/ Differential - everything appears good. WBC: 7.4, RBC: 5.57, platelets: 273, Lymphocytes: 34; Neutrophils 58. All of those fall in the standard range
Also Peripheral Smear - consistent with the normal CBC indices. No abnormalities are identified.
Hep A, B, C - all negative
Comprehensive Metabolic Panel, Lactate Dehydrogenase, Sed Rate

I think the only ones I'm waiting on are HIV - not too worried on that one and ANA - my mother did have Lupus, so that's a concerning one.

No mono but last year I had a cold which turned into bronchitis which turned into LPR. That whole mess lasted 3.5 months from late June to mid October.

I'm rarely around cats or dogs. No sports activity.

My main symptoms were aches/cramps on my side which then moved to my lower stomach area. The feeling of being bloated/full.

For the last two days I just have a slight discomfort above my belly button area. Hard to describe but it feels like I'm bending over and my skin is folded but I'm just sitting on a chair/couch. I'm not that much overweight (5'8 173lbs) where I should feel like that I wouldn't think but that's really the best analogy I can think of.

Thanks again for your thoughts, I appreciate it. I got another 37 hours or so before I see my oncologist/hematologist

[Belial1134]

Oops the : Comprehensive Metabolic Panel, Lactate Dehydrogenase, Sed Rate
I should have added all them were normal as well

[mkh9]

Yes your lab results all look great. The only other thing that comes to mind is appendictis. That is usually lower right abdominal pain. Also your WBC count would be high and you would have a fever if it was really bad enough to make your spleen get swollen. So, not sure here. Let me know how it goes.
mkh9

[Dizzy_1]

I had an enlarged spleen which turned out to be a splenic cyst that ruptured spontaneously. Had to have a splenectomy.

[Belial1134]

Just got back more results a few minutes ago, but I haven't heard from my doctor to understand them. By my googling, looks like I had mono.

I was sick from end of June to Mid-Oct and that was diagnosed as a cold turned into bronchitis turned into LPR (silent reflux). Since I had felt fine since Mid-Oct thru last week of December, I wasn't expecting this and even my doctor had said the timing sounded off (this was before the test results).

Guess I'll call them tomorrow to find out if I read the results correctly

[mkh9]

That would explain the enlarged spleen. I wouldn't go by a mono spot test they are very unreliable. But if they did the Early antigen and Viral capsid antigen and Nuclear antigen. I can help you interpret the tests. Be sure to get the full report such as both IgG and IgM. You can also look at the chart on this website: Scroll down until you find the chart:

http://labtestsonline.org/understanding/analytes/ebv/tab/test/

If you have any questions let me know.

mkh9

[Belial1134]

My doctor said I had it but not necessarily back in July-Oct so he wants me to go thru with the ct scan in March.
Yes, the EBV was 3 results
EBV NUCLEAR AG AB = positive
EBV IGG = positive
EBV IGM = negative

[mkh9]

Yes these results look like past infection. It can't hurt to get the CT scan to at least rule that out.
mkh9

[Belial1134]

Yeah, it's just tough to have to wait until mid March.

I had a few days where I felt normal, but the past few days I've had a little aching on my left side (about where you would put your hand on your hip)
Not quite a cramping feeling though. Maybe it's just my mind working against me (or my anxiety)

The more I think about it, I do believe I was correctly diagnosed in July-Oct with Bronchitis. Back in March/April I became violently sick and thought I was having a heart attack (pain in the upper left shoulder area, could barely talk, write, or think and thought I was going to pass out). The ER Dr said I had a stomach virus/flu and became dehydrated. Two days later I didn't have the pain but did have the weird sensation/little light headedness and was rushed to another hospital and said I was dehydrated again.

Both hospitals did EKGs and blood work but don't think they ever tested for Mono. I don't know how long one stays positive for mono but if it within a year, I would think what I had in March/April was the Mono.

[mkh9]

Yes bronchitis can feel like pneumonia and sometimes like a heart attack. You can get stabbing pain. Same goes for pleuracy. It feels like stabbing pain the ribs. It can be very painful ( I have had it and couldn't stand up straight).  Mono goes away after about 2 months. The swollen lymph nodes can stay longer maybe 4 months. But that is about it. By then it should be negative or past infection in the blood.
mkh9

[Belial1134]

So I ended up back at the Urgent Care today as recommended by my Dr (I couldn't get to his office today before they closed)

Had some intense flank aches/pains/spasms plus a little nausea and chills. He thought I could have a UTI (assuming unrelated to the spleen issue?) but the test came back negative. The Urgent care Dr went ahead and gave me Cipro since I could still have an infection but not show up on the test.

He also said I could show up as having Mono from more than a year ago too. Just seems I am getting so many different answers to every question from the various doctors.  No one seems to have any idea what is wrong and they are just grasping at straws.

[mkh9]

Was the flank pain in the upper right area where the spleen is or in the kidney area? I don't think you have mono again it doesn't recur with symptoms like that. So you don't have a urinary tract infection?  Have you had a test for inflammation like a CRP? I wondering if it is infection somewhere else causing the spleen to enlarge? Another couple of things are H. pylori that causes an ulcer and pancreatitis. With H. pylori you could get a urea breath test. With pancreatitis you could get a blood amylase and lipase. They all can cause pain in the same area.
mkh9

[Belial1134]

The flank pain is actually on both sides kinda where you would put your hands on your hips - but more towards the back than my side.

The best way to describe the pain may be spasms. It seems to come and go and it's both sides.

According to the test I did not have a UTI but both my primary doctor (who couldn't see me that day) and the Urgent Care doctor who did see me said all my symptoms sounded like a UTI - hence the Cipro.

You may be right about the infection somewhere else causing the spleen to enlarge. The urgent care doctor mention that as well but all of the tests that my blood doctor ran came back negative.

I've had 2 CBC's plus a peripheral smear. On one of my CBC's the doctor noted:
No evidence of increased red blood cells on the urine dip with micro analysis.
Pancreatic enzyme normal. Kidney/liver/GB enzymes normal.
No elevated white count or inflammatory markers.

Don't think I had a CRP but I did have a Sed Rate which I thought was a test for inflammation? That was a 5 which I was told was fantastic.

It's just odd how every test yields nothing other than the CT scan and the enlarged spleen. The Blood doctor did say 25% of the time a spleen can enlarge possibly due to an infection but goes down on its own over time, and we never know why it enlarged in the first place.

I can say that other than the flank pain/cramping/spasms, I'm not experiencing the same symptoms that I had when I saw the blood doctor (the fullness/tightness to the stomach - which I was told was a result of the spleen pushing against the stomach).

The urgent care doctor said the issue I have now may not have anything to do with the spleen. I just can't believe my luck to go straight from an enlarged spleen right into a UTI or whatever it is I have. Actually I did have 2 or 3 days of feeling normal before all this started.

Getting to be where I am forgetting what it is like to feel normal.

[mkh9]

Well, it is true that the lymph nodes and spleen can enlarge when you get an infection and then they go down. You may have had some virus or bacterial infection and it went away. The flank pain sounds like a muscle spasm due to a back injury or strain. But other than that I don't know. Your lab work sounds really good. I think the spasms will pass too. Often our immune system fights things off and we don't really know what it is. That is its job. So, I hope you feel back to normal soon. Maybe the flank plain has to do with a kidney infection that is somehow referring the pain downward. But hopefully the cipro will know it out and you will feel better.
mkh9

[Belial1134]

I take the Cipro when I go to bed (around 4am with my schedule) and again when I wake up (around Noon - again, odd schedule of mine)
I'm not sure if it's the Cipro or not, but when I wake up I'm aching and have no energy. A bit nausea as well. After 2 or 3 hours it passes and I slowly begin to feel normal other than the sporadic spasms.

Part of me wants to stop the Cipro but the other part says I should finish the bottle (I got a 10 day supply). If it is a kidney infection, does that generally take longer than a UTI to start feeling better?

Also, I'm not even sure which Dr to try and see next. A gastro? A urologist? I'd guess the kidney falls under urologist?

[mkh9]

Yes kidney infections take longer to heal than a regular UTI because it is deeper into the tissue and not superficial. But you should finish the course of antibiotics. They can make you tired and some nausea. Do they say to take with food or not? Be sure to follow what the directions say. If you are concerned about the kidney infection or kidneys I would see a urologist.
mkh9

[Belial1134]

Bottle just says:
Take with plenty of water
Take 2 hrs before or 6 hrs after antacids, iron, vitamins (I don't take any of those)
Do not take with milk, calcium fortified beverages, or yogurt.

Nothing about taking with food.

I've read all about different side effects of Cipro. So far none of the really nasty ones, so if this can take of the infection or whatever it is that I have, I'll deal with the nausea, fatigue, dry mouth, etc.

I just need to get some energy for the next 2 days (wife's birthday tomorrow and she's off work on Tuesday too)

[mkh9]

I hope it works. There is no guarantee it will. How long have you been on it now? You could call the doctors office and tell them your side effects and ask if those are normal. But it doesn't sound like an allergy more of a side effect. Or it could be that the infection is causing this if that is what you have. Time will tell.
mkh9

[Belial1134]

I talked to my Dr today and he said to stop the Cipro since he doesn't think it's a bladder infection. He called me after the office had closed and said to call tomorrow and set up an appointment sometime this week.

[mkh9]

I wonder if he had an idea of what he wants to do next? Well, at least he is following up with you.
let me know how it goes.
take care,
mkh9

[Belial1134]

He saw me today. Ran more blood work (CBC and CPR) but doesn't think it will show anything.
If it doesn't, he wants me to do a colonoscopy. He's pretty confident it's colon related. Doesn't think colon card but wants to check for irritable bowel disease.
If the colonoscopy rules them out, then he's thinking it's irritable bowel syndrome
From what I understand, both IBD and IBS could result in an enlarged spleen which is of course what the cat scan discovered a few weeks ago. So maybe the pieces are falling into place.

[mkh9]

I guess. Maybe he is looking at the colon overall for other things too besides IBS.  We'll see.  
mkh9

[Belial1134]

As figured, labs came back good.

Dr wants me to go ahead with the colonoscopy but I think I will get a 2nd opinion from a gastro doctor first.  I made an appt for Feb 6th