Resolved question:
I am a 42 yr old male, despBerately looking for answers to symptoms that I'm experiencing: starting over the last 3 months. I would be most appreciative of your comments and opinions on the symptoms I describe below:
I had a rash which started approx 3.5 months ago (before the first 'neurological' symptom of a twitching thumb) - it affected most parts of my body including the trunk, chest arms and legs and presented as a lacy mottled rash - most intense on my arms (the underside of the arms). A dermatologist I saw described it as Levido Reticularis. This still comes and goes with a mild burning and inflamed sensation. The back of my hands also has a reddish rash that also flares and subsides.
3 Months ago I had intense pain deep in the left shoulder which radiated down my left arm. This has subsided very slowly over last 3 months and although not completely gone, it is only a shadow of the pain it was initially.
At the same time as the above, the thumb on left hand began to twitch. The twitching ceased after a couple of weeks, however I noticed that I could feel the tendon in the crease of my left hand between thumb and forefinger - it is very pronounced to touch it you can clearly feel the difference - as you cannot feel the tendon in the crease in the right hand at all.
I have examined both hands closely and it appears that there may be a very slight sign of atrophy on the left hand as opposed to the right but may not be noticeable to anyone else.
Also on my left hand, the thumb knuckle and left little finger knuckle ache pain when tensed. This has remained the same for the last 3 months. However there is no weakness.
3 weeks ago my right thumb has began to twitch (up till now all hand symptoms have been confined to left hand). It has recently ceased twitching.
Also in the last few days I have stiffness and aching in my left wrist and up the underside of my forearm. I also have a stiff ache in my right ankle and up my right calf.
Another symptom that started 3 months ago is a twitch in the lower lid of my right eye. This is intermittent but happens everyday. Over the last 3 months the intensity of the twitch has decreased but it remains present (and is twitching as I write this).
2.5 months ago I started having a very noticeable intermittent electrical'buzzing' feeling in my feet. Both feet 'buzz' but not usually at the same time. The buzz is through the centre of the foot and around the ball of the foot just back from the toes. This was very intense initially and is still present on and off on a daily basis but has subsided in intensity.
3 weeks ago I experienced pain in both ankles and from the outer blade of my right foot across the top of my right foot and to the ankle. This is only noticeable when I roll onto the outer foot when walking and remains the same today, however as I mentioned above I also now feel a stiff ache in my right ankle and up my right calf.
I have also experienced tremors throughout my whole body on occasion over the last 3 months this usually happens late at night whilst laying in bed.
A new symptom from the last few days is a twitch in my left upper thigh.
I was referred by my doctor to a neurologist who examined me and sent me for an MRI of C Spine for which I am still awaiting the results. However from all the reading I have done I cannot see how an issue with the C spine could explain all the symptoms above. Also I feel that the rash may well hold the clue as to what is going on but of course my neurologist was not interested in a rash.
Once again any appraisals, opinions or points of wisdom that can be handed to me at this point would be gratefully received.
Many thanks for taking the time to read through.
Alex
Submitted:
4 Days
Category:
Rheumatologist
Hello,
Thank you for posting your query at DoctorSpring.com
You have elaborated your symptoms quite well, I have few suggestions, livedo reticularis documented, neurological symptoms which are varied and in different part is not territorial to dermatome or blood supply with new onset arthralgias, can happen in many rheumatic conditions.
What about fatigue?
weight loss?
Fever?
Swelling of any joints?
VISION ABNORMALITY?
Any picture suggestive of joint swelling with comparative picture of normal uninvolved site.
Hair loss,oral ulcer,oral dryness, early morning stiffness etc.
any acute phase reports like ESR, CRP? If done provide details about the same.
THYROID FUNCTION TEST, VIT D STATUS, VIT B12 STATUS, COMPLETE BLOOD COUNT AND ANY CHANGE FROM PAST, ANA if done. I need the reports of all of these for a conclusive diagnosis.
Regards,
Dr. Pandey
Hello Dr Pandey,
Thanks you for your response. In aswer to your questions:
What about fatigue? Slight weight loss? Slight Fever? No, but continual sinus issues - blocked or runny nose with loss of smell and taste. Swelling of any joints? Not exactly although an area just below right ankle (the one that aches) is puffy - I will try to take a pic for visual comparison. VISION ABNORMALITY? No
Hair loss? As a 42 yr old male I have a degree of Male Pattern Baldness I take finasteride daily to manage it - have not noticed a noteable increase in shedding. Oral ulcer? Yes about 6 weeks ago - never had one before either. Treated with Bonjella and Anti Flam mouth wash Oral dryness? Yes, mild Early morning stiffness etc. Slight - mainly noticeable in ankles and feet - stiffness and pain.
Bloods: ESR, CRP, Thyroid, Full count etc? I had a full set of bloods including ESR & CRP done back in mid January - results normal at the time. I have just had another full set done and will be getting the results shortly and let you know.
ANA, VIT D STATUS, VIT B12 STATUS - I have not had these done as GP would request only off the back of other abnormal bloods. Although I very much doubt I have any Vit defeciencies.
One last thing to mention is that when the rash flares up as it has just done - on the underside of my forearms as livedo and on the back of my hands as a reddness, it comes with a burning sensation on the skin and causes those areas to feel inflamed in the muscles.
Hope this is useful.
Thanks,
Alex
Dear Alex I will try I simple expression about a disease in evolution. The classical example would be rheumatoid arthritis in evolution were most of the reports will be negative that is ESR CRP etc. the other expression is highly positive arthritis factor like CCP or RF but no disease manifestation. The dilemma is labeling a disease in evolution where it's best guess whether disease is going to regress naturally or progress and which test to order which can be covered under an insurance policy or state policy. In India, I have the liberty to individualize the investigation policy and I would have done an ultrasound of swollen joint and document the site and intensity of inflammatory change if any. I would like pictures of livedo reticularis lesion, joint involved, well this photos would also make your GP understand the changes over a period of time. Please update with pictures if any. Regards