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Bad headaches as if brain hurts and high ANA titres

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A friend of mine (female, 25 years old) has been ill since June of 2012.
Her medical history involves scarlet fever when she was young and her family history is unknown since nobody keeps a record of it since we live in Kuwait. No other illness is noted in her history.

In June of 2012, she started feeling tired all the time, lethargic, not able to breathe properly felt pain all over. The symptoms have progressed over time and as of now, her symptoms are as follow and please be patient with me:

- Really bad headaches and she feels as if her brain hurts. Its persistent from when she wakes up until she sleeps. She was given painkillers and they did not subside the pain. No sleep, water or diet changes affect it.
- Stuffed dry nose, especially the right side. When she sneezes she feels her throat hurts much like when a person has the flu.
- Fever even though a thermometer shows otherwise and her forehead is especially hot.
- Pain in her whole right side of the body.
- Bloated stomach, especially at the "beginning" of the stomach (after the esophagus). Diarrhea
- She feels full all of the time even if she's hungry. She can only eat a small amount and after it she feels full and cannot continue eating. She only eats one meal a day.
- She does not feel like eating even when hungry and feels a burning sensation in the her esophagus and end of esophagus.
-Swollen throat and she feels as if under her jaw is swollen. Lymph nodes there are also swollen and feel tough
- Itchy painful ear
- Cannot sleep well and feels tired all the time
- Random green bruises on her thighs/legs
- Cannot take a deep breath, she feels as if there is an obstruction and it is painful when she tries to breath deeply.
- Racing heart rate
- Low blood pressure
- Grey hair (although maybe from the stress?)
- Swollen nose cartilage
- Gastritis
- Tense muscles
- Was told her vertebrates are out of alignment
- Acne and hair loss

She was diagnosed with systemic candida and was given anti-fungal medicine and had to follow a strict diet. A followup proved she was candida free but some of the symptoms still persisted.
A lot of tests followed and she was diagnosed to be vitamin d deficient and had secondary hyperparathyroidism. A thyroid radiotracer proved normal thyroid and parathyroid activity and the secondary hyperparathyroidism was biochemical. She was told her symptoms were not related to vitamin d deficiency and was given vitamin d injections. She cannot remember how many IUs and the duration but a followup test concluded her vitamin d levels were sufficient but all of the symptoms persisted.

At first, a gastrointestinal disorder was suspected. She saw a gastroentologist who diagnosed her with gastritis but said it was not the cause of her symptoms. She took a biopsy and mentioned slight fibrosis of the stomach mucosa. She gave her medication that did not help. My friend has the medication but not the will nor energy to find them all and tell me their names. Doctor did not ask for any followups
Another doctor ordered many tests, his main finding and the one he felt was most important was high ANA, homogenous pattern. Suspected of SLE, she conducted many tests but was told she did not have SLE.
Then, an autoimmune disorder was suspected and she went to many rheumatologists. One doctor diagnosed her with Sjorgen's but did not give her medication or ask for any followups. She was also tested for celiac, Crohn's, ulcerative colitis, fibromyalgia, rheumatoid arthiritis and was told all are negative and was dismissed with a case of depression by more than a few doctors. She was given a few medications but none worked and the symptoms persisted.

She also had a few X-rays done for her lungs, etc and found no clinically significant results.
In the last few months and after a rheumatologist told her he suspects it is a neurological disorder, he sent her to a neurologist. The neurologist ordered an MRI and immediately told her she has multiple sclerosis due to lesions in her brain. He then suspected it may not be MS and ordered another MRI for her neck region and she performed it at her work place. The doctors at her work place told her all is normal and she did not have MS.
A visit to an ENT doctor told her all of her symptoms were from inflamed nose cartilage and a deviated septum. She is scheduled for an operation but still did not receive a confirmation.
In the last month or two, she performed an Xray for her spine and was told the pressure from the unaligned vertebra are the cause of her symptoms but did not offer any medical advice on what to do.
For the last few weeks she has had a horrible persistent headache from when she wakes up until she sleeps. Her last visit to a doctor gave told her tense muscles were the cause of her issues and gave her vitamin B injections (did not specify which but I think all B vitamins). She does not feel a difference and has been taking them every second day for around a month now.
For the last few days she has been incredibly tired, sleepy, very easily aggravated and a splitting headache and she says she feels her brain is hurting her.

She was given quite a few medications but is in no state to look for them and give me their names. I understand how important this information is and I apologize for its exclusion. She just told me what they do. She was given medicine for: tense muscles (anti-inflammatory), painkillers, stomach medicine but did not specify what (I suspect proton inhibitors?), candida medicine, anti-allergy medicine for her nose, cortisone injections and nasal spray.

I apologize for the haste and poor quality in which this was written but she desperately needs help.

Category: Family Physician-GP

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Category: Internal Medicine Specialist
 32 Doctors Online


Please note your case is being reviewed. Meanwhile our panel has some additional queries. Please reply to them as followups :

1. Could you please say is the most troubling symptom/symptoms ? (like headache ?)

2. Was she ever on steroid medication for more than a week ? (Apart from the cortisone injections)

3. Do you have a recent Fasting Blood Sugar Value or a HbA1C value ?

4. I assume she has been evaluated by a Neurologist (in form of a Physical Examination). If not please let me know.

5. Does she have dry eyes ? gritty feeling in the eyes ? and/or vaginal dryness ?

Thank you

Patient replied :

Hello, she just replied
1) Headache all day long. Bloated and not able to eat or breathe well. Feeling sick after eating.
2) Some nasal sprays may contain steroids.
3) No
4) Yes she was valuated by a neurologist.
5) No dry eyes but sometimes she feel there is pressure on it and it hurts sometimes. No vaginal dryness.

Consult Reply by Dr.Bimalesh Pandey (Rheumatologist), Dr.Vivek Verma (Neurologist), Dr. Deepu Sebin (Internal Medicine Specialist)


We have thoroughly gone through your medical history and records and these are our conclusions:

1. It is not possible to come to a single Diagnosis or conclusion at this point of time, with the available information. We understand that this might be frustration, but unfortunately in some cases this happens.
2. A Rheumatologic disease (SLE / Sjogrens which is still evolving) is the most probable diagnosis. The headache could be unrelated.
3. The good thing is that she has been thoroughly evaluated and all the potentially dangerous conditions have been ruled out. So even though the symptoms are troubling, there are no potentially dangerous issue as of now, with the available information.
4. There appears to have no Neurological illness. The MRI finding is not significant.
5. Symptomatic treatment is the best approach. Migraine type headache needs to considered and treated likewise. She will need pain medication and tryptans. (like Sumatriptan).
6. She can continue her current medications.
7. A tricyclic anti-depressant like Amitriptyline is also recommended . This will help in pain control and elating the mood of the patient. The psychosomatic component of the disease cannot be ignored. A psychiatric consultation might be required for this.
8. Close observation of clinical condition and getting ESR/ CRP regularly, say every three months. Our Rheumatologist also recommends Hydroxycholoroquine as safe drug for your condition.
9. Please get ANA by LIA method again.

Hope this helps.
Please feel free to ask followup questions.

Patient replied :

First of all thank you.
What about the diagnosis of GERD and esophagitis? Would that not account for the breathing issues, pain in the esophagus and discomfort after eating?
She is also asking about the headache and fever. This is her most troubling symptom and she cannot function normally. Would tryptans also help with the fever? Which pain medication would you recommend? Doctors gave her the usual paracetamol, ibuprofen among others with no effect.
Thank you

Consult Reply By Dr.Bimalesh Pandey (Rheumatologist)

Good Question, GERD leads to reflux esophagitis, severe reflux leads to acid aspiration and chemical pneumonitis, pneumonitis and aspiration leads to breathing problem which accentuates on lying down especially at night.
Esophagitis is causes non ulcer dyspepsia and cause of pain.
The question is whether GERD is part of the original problem, which I don't think it to be.

GERD is a separate entity, proton pump inhibitor, prokinetics, change in food habit, sleep hygiene all contribute to good outcome and should be dealt with a gastroenterologist.

If she continues to take usual painkillers, her GERD will worsen and she will have drug induced issues which will have long term issues.

Triptans are good but the matter of fact is which drugs her the best result is any Doctors guess, so the choice can be beta blocker, tricyclic antidepressants like amytriptyline, it can be topiramate especially if she is obese, it can be calcium channel blocker like flunarizine, it can be triptans.

Please document fever and compile daily oral temperature chart t 8 am 12 noon 4 pm and 8 pm.

Hope this helps. Regards

Dr. Bimlesh Dhar Pandey
Category: Internal Medicine Specialist
Senior Residency: Rhematology, All India Institute of Medical Schiences, New Delhi, 2009
Post Graduate, Junior Residency: MD (Internal Medicine), Rajendra Institute of Medical Sciences, Jharkhand, 2006
Residency: Physiology, Institute of Medical Science, Banaras Hindu University, Varanasi, 2003
Internship: Government Medical College, Trichur, 2001
Medical School: MBBS, Calicut University, 2001
Dr. Bimlesh Dhar Pandey and 4 other Medical Specialists are ready to help you

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