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Nightsweats, raised LYMPHOCYTE COUNT with neck LYMPHNODES. ETIOLOGY.

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I have been having night sweats since March.My lymphocite count went up and then went back to normal on September 4th before rising again and then returning to normal this week.

I went for a PET scan and it showed this:Is this ominous?I sweated again last night,sheets very wet.

Here is what the report says: Findings: Head and neck:There are two moderately FDG avid left neck lymph nodes:on transaxial 30 a 9mm level IIA node,SUV 4.2.On transaxial 27 a 6mm level IIb node,SUV 3.8.There is minimal FDG uptake in an 11mm right level IIA node,SUV 2.6.Minor assymetry of uptake in the palatine tonsils,SUV is 5.8 on the right and 4.5 on the left.In the pelvis on transaxial 112 there is a small focus of FDG activity in the left pelvis adjacent to the iliac vessels.It persists on delayed imaging but as there is no correlative CT abnormality,I suspect that it represents focal stasis in the left ureter rather than significant pathology.No FDG avid inguinal adenopathy.No concerning bone lesions.A 9mm well defined mixed lytic sclerotic lesion in the left iliac bone is not FDG avid and likely benign. Impression:There are several hypermetabolic neck lymph nodes as described above as well as minor asymmetry of palatine tonsil uptake.These
findings are quite nonspecific,biopsy would be required to determine etiology.

Category: Oncologist

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Category: Hematologist
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Thank you for your query at DoctorSpring.com.

Dear patient,

It is difficult on your PET findings with so little clinical history.

- Was the a complete evaluation including blood counts and a peripheral smear examination done for you?
- What were the lymphocyte count values?

Your PET CT scan denotes certain areas of increased uptake as per the typed content. I would like to see the complete report with images for better correlation and comment. With this alone, I cannot call it ominous or make any diagnosis as the findings are non-specific.

Night sweat is a common feature in lymphoma, which is a type of cancer of the lymph nodes. However, this may or may not be associated with change in lymphocyte count.

Biopsy of the most enlarged peripheral accessible lymph node as a whole would be the best way to diagnose lymphoma. I would suggest you to fix an appointment with an Oncologist ASAP.

Please revert back with complete reports so that I can help you better .

Kind regards.


Patient replied :

My blood counts were normal the day before the Pet scan.Blood cultures were normal as well as other tests done. My lymphocyte count was 3.5(Canada) which is in the normal range.I do not know how to convert this into the U.S. format.It was as high as 11 in March and has come all the way down. However,my night sweats continue but less severe than in March and April when I was changing my t shirt 12 -14 times per night.Now I sweat around the neck and in the waist and thigh area.When I take my temperature at night during the sweats it is about 97.5F.I have not lost any weight during this period.In March I was diagnosed with the CMV virus and my liver enzymes were all abnormal but now are all back to normal.I do not test positive for CMV any longer.I had a flow cytology test and it showed no cloning in the cells but the CD4 and CD8 cells were inverted.The viral doctor here in Montreal said he has never seen someone with Lymphoma where Lymphocytes go up and then down this much without treatment and therefore thinks it is a virus.

Have you seen a case where Lymphocite counts improve substantially without treatment but the patient had or got Lymphoma nevertheless soon after

Thanks.

Regards,
Richard


Hello,
As I mentioned earlier, Lymphoma may or may not be associated with change in lymphocyte count. In a condition called Richter's transformation of low grade lymphomas to high grade lymphoma / leukemia, there can be change in lymphocyte count. However, they are associated with disease symptoms and other signs of progressive disease. I mentioned it just to keep you aware and informed, but not to scare you.
Lymphoma is not diagnosed based on lymphocyte count. Kindly be assured on this.
I am not sure how big were your nodes which were seen in PET CT scan. My previous comments were based on your PET CT report. Please clarify the need for PET scan which was done in your case.
Regarding your infection with CMV, there can be change in lymphocytes if there is an active or latent or chronic infection.
Hope your concern is addressed. Kindly revert back with queries, if any. Glad to answer them.
Regards.


Patient replied :

Hi,

The size of my nodes are 11mm,9mm,and 6mm.Are these considered big?
Also in the report the radiologist found minor asymmetry of the Palatine tonsil uptake.Is this serious and should this be biopsied as well or just the lymph nodes?
Thank you.


Hello,
No. These lymph nodes are of normal sizes. May be a course of antibiotics can be tried and reviewed again. But I would advise you to meet your physician again and decide on the treatment.

Regards.


Dr. Prasad Eswaran
Category: Hematologist
Experience: 
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

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