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Small painful nodes under armpits and inner thigh region...please help

Let me start with my history...i am 23 male....i encountered pulmonary tuberculosis in 2015 and had my medication for 9 months as i was spitting bloods and my lung was damaged....i constantly follow up with my docs..they always do ct scan and x ray stuff.....reports say that tb left a scar on my lung and it will remain there forever.....at the time of tb(2.09.2015) i was blood transfused....they also test for hiv 1 and 2 antigen 2 days after transfuaion which came negative....after 45 days i was worried searching the net that i might have hiv from blood transfusion at did elisa 3rd gen test..it came negative....fast forward 2018 august i felt pain under my armpit and had several other symptoms like yellowiah tongue,weakness....again googled and end up doing another hiv test...it also came negative(no sexual encounter,or drug abuse ever)...i was relaxed....from october 2018 armpit pain along with inner thigh pain started....i felt small nodes under my right armpit and  inner thigh...pain sometimes comes and then goes...but when i check my armpit by putting my one hand at the back of my head i can feel small little hard and painful to press nodes...couple of them...mostly on right armpit..little on my left armpit...and in right inner  thigh....till date my pain comes and goes...i can feel my nodes as i said under armpit mainly....thing is that when i feel pain i check my nodes and can find them...and they are painful but not swollen...i would say about 1.2 cm the biggest of all....but couple of armpit nodes are little hard...thigh pain troubles say one a gap of 3-4 days........my other symptoms are tiredness,geographic patches on tongue which comes and resolve on their own.........i visted an ENT but he doesn't seem to be concerned much....i am thinking to see a surgeon...please help...
1)should i take a hiv test again(my last hiv test was free of cost as it was from a government hospital....i mean they would have mismatched the samples)?
2)Are lymph nodes hard and painful in hiv or cancer?
3)do pain comes and goes as mine?
...i stay at home for my study purpose after my degree from university...dont even do any exercise.....male 23,5'5,62 kg...please help...and sorry for such a huge question..
3 Responses
1081992 tn?1389903637
Hi, all the details that you provided are very useful. All patients should be like you :)

1) I don't know much about HIV, but I doubt that is involved here. I would instead first think of disseminated (spreading) tuberculosis.

2) With nodes, we always think of how signs *tend* toward cancer or toward not-cancer. A "rock hard" node tends to be cancer from metastasis (spreading). But inflammation (as from TB) can sometimes also cause hard nodes, and even "rock hard" nodes when calcium gets deposited inside.

Nodes that are painful tend to be not-cancer.

3) The pain coming and going seems more like inflammation that gets worse and then lessens. Inflammation causes swelling -- and when the inside of a node swells it presses against the enclosing 'capsule'. That is the usual cause of node pain.

Inflammation is caused by the immune system. Also, a geographic tongue is an odd, unexplained immune system reaction - and that can point to having an overactive immune system. Having an overactive immune system can mean that nodes tend to get enlarged more easily, and that also creates scar tissue inside nodes more easily than is usual for other people.

1.2 cm is not so large as to be automatically worrying about cancer. Did the CT scans tell the shape of any large node, the width x length?

I think you certainly should be concerned because the enlargement of nodes is spreading. But there is not much reason to be concerned about cancer at this point.

You can ask for an ultrasound scan of some of the largest nodes, to see what they look like inside. Cancer destroys the inside of nodes; but TB can sometimes do that, too. Most infections don't do that. However, here is a major point: enlarged nodes from cancer tend to be rounded. From TB, they tend to be long and thin.

A surgical biopsy would tell for sure, but there is some risk to having a biopsy (mainly infection, or an anaesthetic reaction, or a mistake with the scalpel). A needle biopsy has much less risk but is not as sure.

It's complicated and there is even more that can be said. Does this all make sense so far?

Thanks for your so much informative rply..couldnt be better...now

1)My last ct scan was  like on june 2018 but it was a ct scan of thorax....apart from fibrotic opacity in upper lobe of  left lung nothing  abnormal was not mentioned.And that opacity had remained there from my end of treatment as my pulmonary physician mentioned. i would visit the doc again to have a ct scan to find enlarged node for sure.

2)indeed your words make clear sense to me.You have provided so much information which no one can find googling around......this is off topic but i cannot resist myself from asking you ----are you a doctor??? I mean with that pile of information you seem to me.
..there are some more query.....i will be thankful if you answer..

3)do you doubt about recurrent tb or mdr tb??  I completed my medicines without skipping. Regarding the recurrent tb issue i visited my doctors 2-3 times in a month some year ago.They constantly said that i am tb free.I know it can re appear as new infection though...what do you think sir.???
4)what about the thigh nodes?? Could they be related to tb also??
5)my pulmonary expert put me on inhalers  after i developed a cough in 2017....i used to take that occasionally though .......as i felt i was getting better then i stopped it say after a 6 month on-off use.

armpit nodes feels round to me...but thigh nodes are not that round.
1081992 tn?1389903637
No, I'm not a doctor, Sandip. But thank you for the compliments.

3) I don't know a lot about TB, except that it is difficult to kill. But there also is this important fact: often a person's immune system cannot kill off the bacteria, so it instead builds little walls around the bacteria -- with immune cells that join together to try to prevent the bacteria from doing harm. This is called making 'granulomas' in the lungs and also inside of lymph nodes. So maybe some of the TB bacteria can escape the granulomas. Or you might get new TB bacteria: a re-infection. Or maybe dormant TB can get activated, like a zombie coming to life.

Or maybe there are tiny bits of dead bacteria floating around and your over-active immune system reacts to that as it if were a live infection. Have you ever seen a documentary about lions versus hyenas? Imagine dragging pieces of hyena fur through a group of lions; the immune cells 'react'. Overactive immune cells tend to react even more.

Consider this: whenever a person has the flu, all the symptoms that you feel are only from the immune reaction and the powerful biochemicals that get released; you don't feel anything at all directly from the viruses themselves. Biochemicals make lymph nodes react, with or without a live infection.

My guess is there is a live TB infection. The chances of a cancer always exist, but are very low, from what we know so far.

4) The thigh (inguinal) nodes are part of the lymphatic system, which is similar to the system of blood vessels that circulates the blood. So the lymphatic vessels can transport things to the thigh nodes that makes them react.

It would be difficult to tell the shape of nodes without a scan. Ultrasound is best used on nodes that are near the skin, not deep inside. The advantage is that no radiation is used. With a CT, you should have IV contrast to see the nodes' internal structure.

Did the geographic tongue come before or after the TB?
Geographic tongue came 2 years post tb infection.
1081992 tn?1389903637
Then it's possible that the TB infection caused some change in your immune system that resulted in the geographic tongue. That's just a side issue, though.

Your docs might not get worried until/if the nodes get bigger. Then I'd ask for a sonogram, which might lead to a biopsy.

Or maybe the nodes will shrink down instead. Let me know how this goes.

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