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Forum Name: Lymphoma

Question: Swollen Lymph Nodes and Night sweats 23 yrs old


 oakieangel - Fri Jan 12, 2007 9:50 pm

Hi, I am a healthy 23 year old female. I have only a history of past TMJ which was treated with surgery 5 years ago and migranes. I have recently noticed swollen lymph nodes in my neck. They seem to flare up but never actually go away. I am an ultrasound technologist in a radiology department. I have been following the size of the lymph nodes and there are multiple that stay over a cm in AP dimension. The actual length is up to 5 cm from anterior to posterior portion of my neck. The doctor told me not to be concerned about these so I wasnt.

About two months after I noticed the lymph nodes I started having severe night sweats. I started having up to three in one night. I wasn't sleeping and had no appetite so I went back to the Dr who did blood work only to find it was all normal. That was 3 months ago.

I still have the swollen glads and had a CT of my neck done per a Radiologist in my department. It showed several enlarged nodes, with some excreting more contrast than he liked. I am to see a ENT this week. I'm still having the night sweats but only about 2 a week and the glads are still swollen. Is it possible to have lymphoma with completely normal blood work?
My family doctor doesnt think I need to do anything else about it but the radiologist wants me to just incase. I guess I was just wondering if there was anything else that could be causing the night sweats and swollen lymph nodes. The mono test was negative. I would just like to know if anything else could be behind this. I am always tired too. Lately I can't make it a full day at work without completely wearing myself out and needing a 3 hr nap! Thanks-
 oakieangel - Fri Jan 12, 2007 9:59 pm

I forgot to mention that I have not been sick at all during all of this. No fever or flu like symptoms. I feel great except for the exhaustion.
 Dr. Chan Lowe - Fri Jan 12, 2007 11:11 pm

User avatar Those are some large lymph nodes for a long period of time. Now that you are having other symptoms, I would absolutely agree that you should have a work up done.

Are the lymph nodes all on one side and in the same place? Where are the lymph nodes located in the neck-behind the major strap muscle (sternocleidomastoid) or in front of it. The posterior nodes tend to become enlarged much more commonly as a result of a virus. The anterior nodes can also become infected with a bacteria.

Given the night sweats and fatigue I would be concerned about a fungal type infection such as tuberculosis or coccidiodomycosis (Valley Fever). The particular fungus around depends on where you live.

Cat scratch disease is a possibility also if the nodes are all on one side.

I would recommend a ppd test for TB, and blood serologies for cocci. Also, if the nodes have been swollen for that long you may need to have a biopsy done to look at the node.

The best test for lymphoma is going to be a biopsy of the nodes to look for abnormal cells. A blood test may or may not reveal lymphoma.

I encourage you to keep pursuing this. Keep us updated.

Hope this helps.
 oakieangel - Sat Jan 13, 2007 11:14 am

Thanks for the help doctor. The lymph nodes started out just on the right side of my neck. In the past month or two they have appeared on the left side as well. The CT showed some under the strap muscles as well as some above, which are the ones I am feeling. The radiologist that went over the CT with me said there were much more that were about a cm located too deep to feel. There were a couple above the roof of my mouth that I obviously can't feel, some under my clavicle and some in the posterior portion of my neck that I can't feel.

I just had a TB test done in June when I started working at the hospital which was negative. I live in Cincinnati. . I don't know if that can help on a certain type of virus. I work at an outside restaurant that is located on the Ohio River in the summer and one of our regular customers came down with the west nile virus in August. I don't have the same symptoms as he did though. Is that something I even need to mention to the ENT? My glands became noticable in September.

Thanks again for all of your help. I just want to make sure I ask and tell the doctor everything that is important on Tuesday.
 Dr. Chan Lowe - Sat Jan 13, 2007 12:29 pm

User avatar The Ohio River valley area is much less likely to have cocci around. Instead, you have histoplasmosis which can also produce similar symptoms.

With a recent negative ppd it's pretty unlikely to be TB. Your symptoms are also unlikely to be West Nile Virus.

I would discuss your symptoms with the ENT doctor. He may recommend a biopsy given the length of time that this has been going on.

Any chance you were scratched by a kitten in the several months before you started noticing the nodes? If so, cat scratch disease is also a possibility.

Let us know how things are going.
 oakieangel - Sat Jan 13, 2007 8:38 pm

Thanks again for all of your help with this. Another thing I noticed with all of this going on was nausea. I seem to get it atleast once a day and it will last for about an hour. I never actually vomit from it though.
Also, when I was scanning to see if it was possibly related to my gallbladder I found what appears to be a prominent column of Bertin on my Right Kidney. I know these are benign and nothing to worry about but I know for certain that it was not there in June or before that. As an ultrasound student I was scanned almost every class because my anatomy shows up very well.
I guess I was wondering if these can just show up out of no where or if it should be further investigated to make sure it's not a mass. The echogenicity of it is very close to that of the cortex of my kidney. Thanks again.
 Dr. Chan Lowe - Sat Jan 13, 2007 11:07 pm

User avatar Columns of Bertin are considered incidental findings. I'm not aware of how long it can take them to appear. It may also be that the scanning probe was not quite in the right plane to have picked it up previously. The echogenicity you describe is consistent with a column of Bertin.

I suspect that this is unrelated to your symptoms.
 oakieangel - Tue Jan 16, 2007 7:02 pm

So I went to the ENT today who was really kinda short and brief with me. After I waited for 45 mins in the room he finially came in and quickly asked how long this was goin on and felt around then left the room. A minute later a Fellow came in and felt my neck. He then left and they were talking in the hall. Next thing ya know the nurse came in with a prescription for an antibiotic and said to come back in two weeks.
I'll take the antibiotic but I won't be going back to him. I already took antibiotics once for this and it didn't go away (and I told him that!). I am upset I spent my time and money today to just go through another round of this. My family doctor already tried this route. Seems like quite a waste of money to me. I guess I'll take the medicine and deal with the night sweats and fatigue.

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