Discussions By Condition: I cannot get a diagnosis.

doctor unable to diagnose!please help!

Posted In: I cannot get a diagnosis. 10 Replies
  • Posted By: chew_that_guy
  • October 26, 2010
  • 01:35 PM

I have a low grade fever wont go away, morning is 37 and evening around 6.30pm rises to 38 and stay there, cough sometimes, sweat at night, fatigue, loss of appetite, loss weight.Blood test show that I am free from HIV,no VDRL, haemoglobin is 12.7G/DL slightly low,MCHC30G/DL slightly low,platelet count 543x10^9/L high than normal, the rest from the blood test is normal. Sputum result for TB is negative, i think i dont have any sputum, so the sputum test wont work.my chest x-ray report : minimal linear opacities in both perihilar regions,likely represent fibrosis, small clacified granuloma in right upper lobe. The heart and mediastinal configurations are normal, no pleural effusion, osseous structures are unremarkable. Ct head scan is normal, Ct abdomen : the liver is slightly enlarged but is of normal attenuation, no mass or intrahepathic biliary obstruction, the GB appear normal, the spleen is not enlarged, the pancreas is of normal size and shape, both kidneys are of normal size, shape, excretion, no obstruction seen,no free fluid, lung bases appear normal. Doctor suspect TB in my body but cant get any prove from the tests, i had a mantoux skin test on TB, result 10mm raised red spot but doctor cant confirm TB infection, but still doctor prescribe medicine for curing TB for me to eat . I accompanied my wife to hospital for straight 6 days of pneumonia treatment, we were at the hospital for 4 to 5 hours for 6 days, then she was cured, i began to have cold, i took tylenol, cold went away in 3 days, then diffuclt to breath , found out lot of mucus in my bronchitis, went to hospital for 6 days injestion for asthma(i was falsedly diagnosed as asthma by doctor, mucus wont go away, then i took mucoslovan for 3 days, then my mucus went away, i thought i was cured, this happened in mid of July, then earlier of Sep, mucus and shortness of breath came back again,i was so upset with the doctor in shenzhen china, i worked in shenzhen china, so i decided to go back to malaysia for treatment. went to see a ENT specialist, had a surgery on my nose to clean the infection and throat to clean the infection too, then after the surgeries and i can breath easily, no more mucus , but my low grade fever wont go away, then I was refered to a internal medicine and respiratory specialist, the specialist suspect i have TB but cant prove that i have TB through bloodtest, chest x-ray test, ct head, ct abdomen test. But still prescribe me a TB medicine to take because specialist told me that i have evening fever, some cough, fatigue, loss weight, loss of appetite, night sweat. Please any doctor here can help me? I feel hopeless, and sad, why modern medical devices cant diagnose what kind of disease do i have, please any doctor help me

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  • I have a low grade fever wont go away, morning is 37 and evening around 6.30pm rises to 38 and stay there, cough sometimes, sweat at night, fatigue, loss of appetite, loss weight.Blood test show that I am free from HIV,no VDRL, haemoglobin is 12.7G/DL slightly low,MCHC30G/DL slightly low,platelet count 543x10^9/L high than normal, the rest from the blood test is normal. Sputum result for TB is negative, i think i dont have any sputum, so the sputum test wont work.my chest x-ray report : minimal linear opacities in both perihilar regions,likely represent fibrosis, small clacified granuloma in right upper lobe. The heart and mediastinal configurations are normal, no pleural effusion, osseous structures are unremarkable. Ct head scan is normal, Ct abdomen : the liver is slightly enlarged but is of normal attenuation, no mass or intrahepathic biliary obstruction, the GB appear normal, the spleen is not enlarged, the pancreas is of normal size and shape, both kidneys are of normal size, shape, excretion, no obstruction seen,no free fluid, lung bases appear normal. Doctor suspect TB in my body but cant get any prove from the tests, i had a mantoux skin test on TB, result 10mm raised red spot but doctor cant confirm TB infection, but still doctor prescribe medicine for curing TB for me to eat . I accompanied my wife to hospital for straight 6 days of pneumonia treatment, we were at the hospital for 4 to 5 hours for 6 days, then she was cured, i began to have cold, i took tylenol, cold went away in 3 days, then diffuclt to breath , found out lot of mucus in my bronchitis, went to hospital for 6 days injestion for asthma(i was falsedly diagnosed as asthma by doctor, mucus wont go away, then i took mucoslovan for 3 days, then my mucus went away, i thought i was cured, this happened in mid of July, then earlier of Sep, mucus and shortness of breath came back again,i was so upset with the doctor in shenzhen china, i worked in shenzhen china, so i decided to go back to malaysia for treatment. went to see a ENT specialist, had a surgery on my nose to clean the infection and throat to clean the infection too, then after the surgeries and i can breath easily, no more mucus , but my low grade fever wont go away, then I was refered to a internal medicine and respiratory specialist, the specialist suspect i have TB but cant prove that i have TB through bloodtest, chest x-ray test, ct head, ct abdomen test. But still prescribe me a TB medicine to take because specialist told me that i have evening fever, some cough, fatigue, loss weight, loss of appetite, night sweat. Please any doctor here can help me? I feel hopeless, and sad, why modern medical devices cant diagnose what kind of disease do i have, please any doctor help meOh wow. Symptoms of pulmonary tuberculosis, but tests say otherwise. An interesting case indeed.Mycobacterium avium complexMycobacterium avium complex (MAC) is a group of genetically related bacteria belonging to the genus Mycobacterium. It includes Mycobacterium avium subspecies avium (MAA), Mycobacterium avium subspecies hominis (MAH), and Mycobacterium avium subspecies paratuberculosis (MAP).Historically, MAC has also included Mycobacterium avium intracellulare (MAI) – a distinct species of bacteria.MAC bacteria are common in the environment and cause infection when inhaled or swallowed. Symptoms of MAC diseases are reminiscent of tuberculosis. They include fever, fatigue, and weight loss. Many patients will have anemia and neutropenia if bone marrow is involved. Pulmonary involvement is similar to TB, while diarrhea and abdominal pain are associated with gastrointestinal involvement. MAC should always be considered in a person with HIV infection presenting with diarrhea. Recently, M. avium has been found to deposit and grow in bathroom shower heads from which it may be easily aerosolized and inhaled.The various subspecies are prevalent in different areas:MAA primarily affects birds, but has also been found in the group of mammals known as ruminants, especially deer;MAP causes paratuberculosis, or Johne's Disease;MAH is responsible for most MAC diseases in humans, including hot tub lung and Lady Windermere syndrome. MAC disease is common in immunocompromised individuals, including senior citizens and those suffering from HIV or cystic fibrosis; however, the MAC diseases, particularly Lady Windermere syndrome, do not require that the individual be immunocompromised.Has your physician ever considered Nontuberculous mycobacteria?
    keanhe 86 Replies
    • October 27, 2010
    • 00:45 PM
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  • Please remember that TB can also take more than a mere PPD to diagnose. TB skin tests can be unreliable. Also consider that TB can manifest in many different clinical presentations, and that treatment can be terribly complex, often taking up to a year on a multidrug regimen (once the correct combination is found) depending on which strain is causitive and which drugs it happens to be resisant to in the area you live. And no matter where you are antibiotic treatment for TB will take much longer than 6 weeks at a crack. Period. Based on your post, an undertreated, multidrug resistant strain is much more likely to be the culprit in your case.
    gregtfish 67 Replies
    • October 28, 2010
    • 04:12 AM
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  • Oh wow. Symptoms of pulmonary tuberculosis, but tests say otherwise. An interesting case indeed. Mycobacterium avium complex Mycobacterium avium complex (MAC) is a group of genetically related bacteria belonging to the genus Mycobacterium. It includes Mycobacterium avium subspecies avium (MAA), Mycobacterium avium subspecies hominis (MAH), and Mycobacterium avium subspecies paratuberculosis (MAP).Historically, MAC has also included Mycobacterium avium intracellulare (MAI) – a distinct species of bacteria. MAC bacteria are common in the environment and cause infection when inhaled or swallowed. Symptoms of MAC diseases are reminiscent of tuberculosis. They include fever, fatigue, and weight loss. Many patients will have anemia and neutropenia if bone marrow is involved. Pulmonary involvement is similar to TB, while diarrhea and abdominal pain are associated with gastrointestinal involvement. MAC should always be considered in a person with HIV infection presenting with diarrhea. Recently, M. avium has been found to deposit and grow in bathroom shower heads from which it may be easily aerosolized and inhaled. The various subspecies are prevalent in different areas: MAA primarily affects birds, but has also been found in the group of mammals known as ruminants, especially deer; MAP causes paratuberculosis, or Johne's Disease; MAH is responsible for most MAC diseases in humans, including hot tub lung and Lady Windermere syndrome. MAC disease is common in immunocompromised individuals, including senior citizens and those suffering from HIV or cystic fibrosis; however, the MAC diseases, particularly Lady Windermere syndrome, do not require that the individual be immunocompromised. Has your physician ever considered Nontuberculous mycobacteria? Thanks for you opinion, doctor has not considered any out of the TB bacteria yet, but I will bring this up to the doctor, previously, before taking TB medicine, my temperture rose to 38.2 the highest, after taking the Tb medicine, body temperature drop a little, the highest is 37.8 but today, i had a lung Ct scan, and this evening I took my body temperature, it rose back to 38.1, I am not sure if the fluid injection of the CT scan I took which made my heart beats faster and hence body temperature rises?
    chew_that_guy 5 Replies
    • October 28, 2010
    • 11:22 AM
    • 0
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  • Please remember that TB can also take more than a mere PPD to diagnose. TB skin tests can be unreliable. Also consider that TB can manifest in many different clinical presentations, and that treatment can be terribly complex, often taking up to a year on a multidrug regimen (once the correct combination is found) depending on which strain is causitive and which drugs it happens to be resisant to in the area you live.And no matter where you are antibiotic treatment for TB will take much longer than 6 weeks at a crack. Period.Based on your post, an undertreated, multidrug resistant strain is much more likely to be the culprit in your case. Thanks Greg, tomorrow I will get my lung Ct scan, and I will talk to my doctor, I will post the update here, thanks guys.
    chew_that_guy 5 Replies
    • October 28, 2010
    • 11:25 AM
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  • I have a low grade fever wont go away, morning is 37 and evening around 6.30pm rises to 38 and stay there, cough sometimes, sweat at night, fatigue, loss of appetite, loss weight.Blood test show that I am free from HIV,no VDRL, haemoglobin is 12.7G/DL slightly low,MCHC30G/DL slightly low,platelet count 543x10^9/L high than normal, the rest from the blood test is normal. Sputum result for TB is negative, i think i dont have any sputum, so the sputum test wont work.my chest x-ray report : minimal linear opacities in both perihilar regions,likely represent fibrosis, small clacified granuloma in right upper lobe. The heart and mediastinal configurations are normal, no pleural effusion, osseous structures are unremarkable. Ct head scan is normal, Ct abdomen : the liver is slightly enlarged but is of normal attenuation, no mass or intrahepathic biliary obstruction, the GB appear normal, the spleen is not enlarged, the pancreas is of normal size and shape, both kidneys are of normal size, shape, excretion, no obstruction seen,no free fluid, lung bases appear normal. Doctor suspect TB in my body but cant get any prove from the tests, i had a mantoux skin test on TB, result 10mm raised red spot but doctor cant confirm TB infection, but still doctor prescribe medicine for curing TB for me to eat . I accompanied my wife to hospital for straight 6 days of pneumonia treatment, we were at the hospital for 4 to 5 hours for 6 days, then she was cured, i began to have cold, i took tylenol, cold went away in 3 days, then diffuclt to breath , found out lot of mucus in my bronchitis, went to hospital for 6 days injestion for asthma(i was falsedly diagnosed as asthma by doctor, mucus wont go away, then i took mucoslovan for 3 days, then my mucus went away, i thought i was cured, this happened in mid of July, then earlier of Sep, mucus and shortness of breath came back again,i was so upset with the doctor in shenzhen china, i worked in shenzhen china, so i decided to go back to malaysia for treatment. went to see a ENT specialist, had a surgery on my nose to clean the infection and throat to clean the infection too, then after the surgeries and i can breath easily, no more mucus , but my low grade fever wont go away, then I was refered to a internal medicine and respiratory specialist, the specialist suspect i have TB but cant prove that i have TB through bloodtest, chest x-ray test, ct head, ct abdomen test. But still prescribe me a TB medicine to take because specialist told me that i have evening fever, some cough, fatigue, loss weight, loss of appetite, night sweat. Please any doctor here can help me? I feel hopeless, and sad, why modern medical devices cant diagnose what kind of disease do i have, please any doctor help meI've been reviewing literature and can't find any reasons/reports of CT contrast would raise your temperature, so it's your illness.By the way, please ask your physician to order a histoplasma skin test, as histoplasmosis causes a low-grade fever (especially rising in the evening), lung calcification granulomas, perihilar fibrosis, enlargement of the liver, most of the symptoms you described, and resembles tuberculosis.Feel better bud.
    keanhe 86 Replies
    • October 28, 2010
    • 00:55 PM
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  • I've been reviewing literature and can't find any reasons/reports of CT contrast would raise your temperature, so it's your illness. By the way, please ask your physician to order a histoplasma skin test, as histoplasmosis causes a low-grade fever (especially rising in the evening), lung calcification granulomas, perihilar fibrosis, enlargement of the liver, most of the symptoms you described, and resembles tuberculosis. Feel better bud.Yesterday, i took my body temperature at 6.30am it was 36.9 and the highest was 37.8 at around 7pm. I brought up the NTMB to the doctor, and she ruled out that in me, said that NTMB is very common in HIV patient and is very very rare in NON-hiv patient. Liver slightly enlarged might dued to the TB medicines which I take daily.And I had a CT scan of the thorax on my lung,result came out that no eveidence of any focal lung lesion, no endobronchial lesion seen, subcentimeter anterior carinal and anterior mediastinal lymph nodes. Doctor asked me to have the lung Ct scan again in 2 to 3 month's times see if the lymph node is getting larger,if yes then biopsy of the lymph should be performed to find out the cause. Doctor asked me to take the TB medicines till 15th of Nov and go back for a routine checkup since she said that I had a slight 0.2 decreased of my evening body temperature. I will talk to doctor about the histoplasma . By the way, I am now taking ripampicin 600mg, ethambutol 1000mg, isoniazid 300mg, pyridoxine B6 10mg, pyrazinamide 50mg daily, thanks kean. will update further
    chew_that_guy 5 Replies
    • October 31, 2010
    • 01:56 AM
    • 0
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  • Avoid sugar, and all foods with added sugar.Keep warm at all times.I suggest, get some eucalyptus oil -100% if possible - not diluted. Put it near where you sleep at night, so you will inhale the vapor. It is a good idea to put it on each end of the pillow. Inhaling eucalyptus oil, kills infecting organisms in the lungs, and should prevent serious infections in the future.TB, and some other respiratory infections, can live in places where the immune system may not be able to get to them, and where the eucalyptus oil may not reach them, for example they may be surrounded by a pocket of pus. The body can eliminate this pus more effectively when the internal chemistry is alkaline. I suggest using an alkalizing product. These should be available in health food stores. You mix a small amount in water, and drink the water. If you can't get one of these, and you don't have high blood pressure, you can use sodium bicarbonate, which is sold as baking soda. Consuming sodium can increase blood pressure. People with high blood pressure should balance this with potassium bicarbonate. It is best for people with high blood pressure to use a alkalizing product from the health food store.As the body eliminates these pockets of pus, and the infecting organisms are released, you may temporarily get more severe respiratory infections. It is important to keep using the eucalyptus oil to prevent this from getting too severe.
    Anonymous 42789 Replies
    • October 31, 2010
    • 03:17 AM
    • 0
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  • Thanks for your suggestion buddyAvoid sugar, and all foods with added sugar. Keep warm at all times. I suggest, get some eucalyptus oil -100% if possible - not diluted. Put it near where you sleep at night, so you will inhale the vapor. It is a good idea to put it on each end of the pillow. Inhaling eucalyptus oil, kills infecting organisms in the lungs, and should prevent serious infections in the future. TB, and some other respiratory infections, can live in places where the immune system may not be able to get to them, and where the eucalyptus oil may not reach them, for example they may be surrounded by a pocket of pus. The body can eliminate this pus more effectively when the internal chemistry is alkaline. I suggest using an alkalizing product. These should be available in health food stores. You mix a small amount in water, and drink the water. If you can't get one of these, and you don't have high blood pressure, you can use sodium bicarbonate, which is sold as baking soda. Consuming sodium can increase blood pressure. People with high blood pressure should balance this with potassium bicarbonate. It is best for people with high blood pressure to use a alkalizing product from the health food store. As the body eliminates these pockets of pus, and the infecting organisms are released, you may temporarily get more severe respiratory infections. It is important to keep using the eucalyptus oil to prevent this from getting too severe.
    chew_that_guy 5 Replies
    • November 10, 2010
    • 05:32 AM
    • 0
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  • Yesterday morning, my body temperature wat 36.2 at 5 in the morning, and peaked at 7pm at 37.5. it came down a bit, felt like I feelt better averall, hope body temperature will continue to drop. Not sure I am on the right track? Yesterday, i took my body temperature at 6.30am it was 36.9 and the highest was 37.8 at around 7pm. I brought up the NTMB to the doctor, and she ruled out that in me, said that NTMB is very common in HIV patient and is very very rare in NON-hiv patient. Liver slightly enlarged might dued to the TB medicines which I take daily.And I had a CT scan of the thorax on my lung,result came out that no eveidence of any focal lung lesion, no endobronchial lesion seen, subcentimeter anterior carinal and anterior mediastinal lymph nodes. Doctor asked me to have the lung Ct scan again in 2 to 3 month's times see if the lymph node is getting larger,if yes then biopsy of the lymph should be performed to find out the cause. Doctor asked me to take the TB medicines till 15th of Nov and go back for a routine checkup since she said that I had a slight 0.2 decreased of my evening body temperature. I will talk to doctor about the histoplasma . By the way, I am now taking ripampicin 600mg, ethambutol 1000mg, isoniazid 300mg, pyridoxine B6 10mg, pyrazinamide 50mg daily, thanks kean. will update further
    chew_that_guy 5 Replies
    • November 10, 2010
    • 05:36 AM
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  • Yesterday morning, my body temperature wat 36.2 at 5 in the morning, and peaked at 7pm at 37.5. it came down a bit, felt like I feelt better averall, hope body temperature will continue to drop. Not sure I am on the right track?Your temperature will always be lower in the morning and higher in the evening. The normal body temperature peaks at a little after approximately 6:00 pm, while reaching it's lowest at approximately 4:00 am. Do not let that determine your progress, let the way you feel do. If your feeling better overall, we're happy for you, just make sure you continue to follow the guidance of your physician.
    keanhe 86 Replies
    • November 10, 2010
    • 00:39 PM
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