Chronic diarrhea, anemia, cold hands, headaches, fever

[JimmyJazz]

My 33 year old African American girlfriend has a history of stomach ulcer, GERD, anemia, heavy menstruation and cramping, anxiety/depression and asthma.  In 09/08, after returning from Mexico, she had severe lower left abdominal pain radiating to her back, and eventually high fever, dehydration, vomiting, and black diarrhea.  She finally got some antibiotics and the most severe symptoms resolved.

Since then though, she's had chronic unremitting diarrhea (no evident blood anymore, although occasionally oily) and severe anemia (her lowest blood count was 8).  She's also experienced migraine like headaches, neck pain, low grade fever, vertigo, and extreme fatigue.  Her symptoms always get worse during her period.  At her worst, she's had tingling in her fingers and blurred vision.  Recently, her hands become freezing cold and clammy immediately after eating.  She occasionally gets nauseous immediately after a meal.  She has a good appetite though.

She's had an endoscopy and colonoscopy, neither of which showed anything (in fact, her stomach ulcer has healed).  Her glucose test in November was normal.  Negative for parasites.  Her B12 is normal (although when I give her sublingual B12 she's not headachey).  Her lymph nodes do not appear swollen.  She is on iron supplements but probably not enough due to her gastric problems.She's on Lexapro for the anxiety and it's helping.  She's fairly stable right now and is still working, but just exhausted.

She's getting very tired of tests and is ready to just give up trying to diagnose this, but she's agreed to see a rheumatologist as I think this might be lupus and/or fibromyalgia. I also want to test for celiac, which her gastroenterologist already ordered but she hasn't done.

Any other ideas?

[Bhupinder Kaur, MD]

Hello,

Lupus can be a possibility as it presents with achy or swollen joints, persistent, fever,extreme fatigue,skin rashes,anaemia and fingers turning cold on exposure to cold.But it is also important to find out the cause of anemia as anemia can also lead to such symptoms also.It is also important to rule out inflammatory bowel disease and irritable bowel syndrome.In my opinion,your girlfriend should consult a physician and get ANA and ESR done to rule out lupus.

Hope it helps.Take care and regards.

[JimmyJazz]

Forgot to mention a big one: she had carpal tunnel last year (before the Mexico trip) that was successfully resolved with cortisone injections.  One of the big reasons I'm thinking Lupus.