Resolved question:
37 year old male, generally healthy. I have a personal and family history of migraine headache. I have a history of fasiculations in my legs that began about 15 years old patientago that were more or less generally present. About 3 years old patientago I noticed some cramping, rubbery leg feelings and the fasiculations spread throughout my whole body (face, legs, arms, back, hands, etc.) Was diagnosed with benign fasiculation syndrome by doctor who had specialization in ms...they went away completely after about 8 months and appeared again in about April of this year. About the same time, (roughly 4 months ago) I underwent a full neurological consult for my headaches as the pattern had changed. The comprehensive neurological exam was completely normal and MRI of brain was done and also normal. The fasiculations have continued all over although not as frequent. I have developed pain in my shoulder (without a known injury) that sort of migrated to my mid and lower back and side along with some other aches and pains I experience stiffness that is generally worse in the morning (it feels a bit like a side stich) and some fatigue but nothing major. Never had emg performed as there is no weakness or clumsiness but occasionally get the rubbery leg feeling from time to time...it comes and goes.
I have a family history of sort of nebulous mixed connective tissue disease. Grandfather died from it and mom has displayed signs as well, erronously being diagnosed at one time with both lupus and ms. Father has a history of arthritis and joint swelling though not rheumatoid. His mother had rheumatoid arthritis and both my parents suffered from complicated migraine when they were younger. The doctor here mentioned ankylosing spondylosis and possible fibromyalgia as things to look for. She ordered a full lab panel.
RF Immunoturbodometric: Normal
Thyroid Function Tests: Normal
Renal Function Tests : Normal with the exception of slightly elevated urate 0.43 (range 0.20-0.42)
Serum B 12 and Folate: Normal
Diabetic profile: Normal
ESR: Normal
CBC: Normal with the exception of slightly elevated Monocytes 1.14 (Range 0.20-1.00) and Eosinophils 0.56 (range less than 0.51)
CRP: High 20 (range less than 5)
Liver Function tests: Normal with the exception of slightly elevated ALT 49 (range less than 45)
Ferretin: slightly high 406 (range 20-400)
Lipid Panel : Normal
X-Rays were performed:
Lumbar Spine "There is some narrowing of the L5/S1 disc space. This may be wholly or partially developmental. Otherwise the vertebral bodies and disc spaces are normal. No evidence of spondylolisthesis or spondylolysis. Normal sacroiliac joints.
Thoracis Spine "No focal or vetebral or disc space abnormality identified. Normal paraspinal soft tissues.
In your opinion what is the next step or thoughts on possible diagnosis? I know both of the above conditions can be very difficult to diagnose. The doctor here has referred me to a musculoskeletal specialist.
Submitted:
4 Days
Category:
Rheumatologist
Hello,
Thanks for the posting your query at DoctorSpring.com
I have gone through the report and query that you have.And I would like to highlight two things Early morning stiffness and pain in the back and very well described shoulder pain mid thoracic pain etc' with high CRP and normal sacroiliac joint.
the CRP is high because of inflammation and where is it, in the spine. why is xray pelvis normal because there is no irreversible damage, what to do, please get HLA B 27 by PCR, which your specialist will ask/ order.
My diagnosis probable Spondyloarthritis axial form pending HLA B 27 report with high disease activity with high ASDAS CRP value.
if you have any query kindly feel comfortable to ask.
Regards.