Dr. Shahad Alshehri
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a cold which led to swollen lymph nodes for five months. A few months back, I had swollen glands in my neck which was present for months. Blood work was abnormal and doctors could not figure out what it was. I have taken multiple blood tests, two CT scans, and a biopsy. I feel fine with no symptoms. The only symptom I ever had was a cold at the beginning which was followed by swollen lymph nodes. I also need to share that my brother had the same thing with the swollen nodes being much smaller. He actually had a cold first and then I got it two weeks later. Both of us had swollen lymph nodes. He has them now in the back of his neck, mine are in the front. My blood work says lymphocytes are abnormal with cytoplasmic villi and also occasional ones show cytoplasmic projections. I am looking for someone to tell me what I have and how it should be treated. Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern.
I have reviewed the files you have attached (attachments removed to protect the patient's identity).
Before going into more details, I would like to reassure you that most of your laboratory workups are acceptable and there is no blood test result that is alarming or requires immediate action. Your viral panel that included hepatitis and HIV (human immunodeficiency virus) was all negative. The ANA (antinuclear antibody) is high (1:160) and it means you have an inflammatory process going on.
I hope this has helped you.
Thank you.
The Probable causes
Investigations to be done
Differential diagnosis
Treatment plan
Preventive measures
Regarding follow up
Patient's Query
Hello doctor,
Thank you for your reply.
I will describe my symptoms in detail again.
A few months back I felt tired and weak one day. I forced myself to work out and then after that, I slept all day. After two weeks, I developed a swollen lymph node and went to the doctor. The doctor gave me Augmentin. I took it for six days and the lymph node almost disappeared. A week later the lymph node got way bigger. I went to another doctor who did a CT scan and said it is normal. He also said that it is an infection and my body is fighting it. The doctor gave me Augmentin for two weeks. And I felt much better, the swelling went way down but it was still there.
After three months, I went to a third doctor who did a CT scan and suggested that I have dry cough. He did not give me anything.
Again after two months, I went to another doctor who did a CT scan, biopsy, FNT, and chest X-ray. TB test was negative. There was nothing else except the swelling which was smaller in size when compared to the prior month. However, two months later, the lymph node disappeared and the doctor said there is something wrong with my blood work. Please clarify.
Thank you.
Hello,
Welcome back to icliniq.com.
I am glad the lymph node disappeared, which means it was most likely a reaction to a previous illness or Kikuchi-Fujimoto disease, which is usually diagnosed by histopathology and has a good prognosis.
I will elaborate on your blood finding in detail. Your peripheral blood smear showed the lymphocytes are pleomorphic where reactive lymphocytes are present. Some lymphocytes are abnormal with cytoplasmic projections.
In detail, we have our lymphocytes increasing when we have an infection, autoimmune disorder, or a disease in the lymphatic system. Lymphocytes are a form of white blood cells that fight against diseases in the body. Lymphocytes with cytoplasmic projections are usually considered abnormal findings for which further testing is needed. It is called immunophenotyping of peripheral blood smear, to compare the cells and to detect white blood cells antigens and markers like these projections to identify the cause.
I have seen your lab reports (attachment removed to protect the patient's identity), and I think it has not been done yet. It will help in checking the cause of the finding that is worrying you. If it is inconclusive, further testing might be performed, and of course, a hematologist's input will be needed.
I hope this answers your question and reassures you for the time being until further test is done on your blood to detect the abnormality and check your cells. Until then, you do not need to do anything or take any medication.
If the findings of the blood immunophenotyping are abnormal, a further check on your blood and bone marrow is needed to investigate lymph proliferative disease.
I hope this has helped you.
Thank you.
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