QuestionI'm a 46 year old Caucasian female. 5'1"and weigh 130#. Ihad a CBC,basal metabolic panel,urinalysis & liver & lipid profile done June 2007-all were WNL except a WBCof 11.8 (ref.range 4.1-10.9) & neutrophils 8.6(ref.range2.0-6.9). ARNP-C said nothing to worry about. Around July 19th I began feeling fatigued easily,joint pain, L lower back,hip and leg pain, running a low grade temp of 99.0-100.7. Isaw ARNP-C who dx:sinusitis and sciatica. I took a 10 day course of Avelox and a muscle relaxant. I returned to the ARNP-C on Aug. 6th as I continued to run the fever, fatigue worsened,pain in L lower back,hip and leg continued, nausea. I was placed on Phenergan and Cipro 500mg twice a day and Clindamycin 300mg twice a day for 2 weeks. At that time we repeated a CBC and urinalysis. Urine was WNL. WBC 13.3(ref. range 4.1-10.9) and neutrophils of 10.3 (ref rang 2.0-6.9).I returned to the ARNP-C who had me see the MD on Aug. 21st as the fever continued, as did the sciatic pain and now I'm having intermittent nausea, vomiting & diarrhea,dizziness,lightheaded,almost fainted 3 times,no appetite.My MD suspects sepsis with ? endocarditis and is trying to locate origin of infection. On Aug.23 I had the following test: CT of the Abdomen & Pelvis which showed a uterine mass ,most compatible with fibroid & a left hepatic lobe cyst,otherwise unremarkable exam. CXR-no evidence of acute cardiopulmonary process.MRI of lumbar spine-Impression: mild focal left paracentral disc protrusion at L4-L5.Otherwise,unremarkable exam. Echo-Pending final results although technician has 25+ years experience said looked WNL. MD was looking for endocarditis. Limited CT paranasal sinuses w/o contrast.Impression:1. The orientation of the presented images is questioned.This should not be considered a final interpretation until this can be confirmed with respect to nasal fossa findings 2. The paranasal sinuses are all clear.3. In the presented images,the nasal septum is severely deviated to the right & there is prominent hypertrophy of left inferior nasal turbinate mucosa. I've had extensive dental work, all but 6 teeth have either caps,crowns or bridges thus making scan very difficult. Mono spot test,liver panel,MRSA culture of nares & strep- all WNL.Blood cultures neg,but where done w/o chills. I returned to the MD on Sept.4th-he still suspects sepsis and feels blood cultures were inconclusive due to not having chills when drawn.We drew another CBC & a repeat urinalysis & is still looking for site of origin of infection-I don't have results yet. I took a stool sample in for C-diff,toxins & leukocyte count today. I'm scheduled for a HIDA scan on 9/12 and a U/S of gallbladder on 9/21 as I'm now having abdominal tenderness and all other symptoms continue. It's been 8 wks and 3 antibiotics which MD feels should have cleared most bacteria. Saw GYN on 8/30 who feels fibroid is benign. Any insight would be greatly appreciated. I'm a Home Health RN and u/a to work until a confirmed dx is established and the dizziness, faint feeling and lightheadedness goes away, as I can't drive. I also have an autistic teenager and don't have time to be sick.I return to the MD on 9/11 for a F/U,as he is very concerned that we can't find the site of origin.
AnswerHi Mary,
Thanks for the very detailed message. This is a conundrum for sure. Some things I would be interested in would be rheumatic disease testing (RA, ANA, Sed Rate and CRP), lyme titer and a comprehensive metabolic panel to see if the liver functions have changed. The diarrhea could be antibiotic induced as could the dizziness and the anorexia. There is probably some relative dehydration from the diarrhea as well. This is the best I can offer considering what has been already done.
