Any insight?

[laxmomut]

Hi, I wanted to get some direction & hoping someone has had some experience/advice.

In Sept I went to my doctor because I was feeling tired & just got to the point I couldn't even workout for 30 min a day. He did bloodtest and everything was generally normal except a positive Epstein Barr. I told him I didn't think I had mono (I had it 2 years prior and this didn't feel like mono). I took a week off work, started feeling better and returned to work. I had other symptoms come on in Oct as well.

The beginning of December I went in again because I was feeling the fatigue again. Blood test again came back normal except I was still positive for Epstein (he said the acute phase-I had never created the antibody to move past the 1st phase). I was put on a leave from work for a month while I was referred to an Infectious Disease doctor for the Epstein. About 3 weeks after my leave I started to feel better but still tired, napping everyday, etc.

I saw the ID disease doctor at the beginning of Jan and was still positive for Epstein Barr & she concluded I had a false-positive Epstein Barr or 5% of population that wont create the antibody. My CRP was a 1. Went back to work and within a couple weeks started feeling bad again. Flu like body aches, pain in my hips & knees, very forgetful-just felt like I was in a fog all the time. I went back to my doc & asked for a RA and ANA test. Ana direct came back abnormal high positive, RA was normal. I also suddenly had high blood pressure that has required me to go on blood pressure medication and even with the medicine is still elevated. I have always had great blood pressure. It started slowly creeping up when I was sick but nothing for concern until Feb when I was consistently 160/109'ish. EKG showed my heart looked great though.

He referred me to a Rheumatologist saying I could have an autoimmune disease like Lupus. I saw her two weeks ago & she ordered more testing. At the time she said my CPR was elevated so she wanted to check that again. My ANA direct is positive, IFA is negative, and my ANA DNA was normal @ 1. My CPR is now an 8.9 and I came back positive for Antiscleroderma-70 antibodies.

Over the phone I kind of got the blow off by the nurse. Said that because I don't have symptoms of the soft tissue AD that came back positive (Scleroderma) she wouldn't diagnose me with that and just to have my CRP checked again in 6 months. I agree that I don't have the symptoms, from what I've read. I am more concerned about my CRP increasing that much, and she a 1 was "elevated", the antibody tests that were positive and the belief from ID doctor that something is causing a false-positive Epstein Barr.

Anyone have any advice or direction for me? I have been feeling "sick" since Sept and just want to figure out what's wrong with me. Up until Sept, I was a healthy & active person. Now...not so much I'm tired just getting through the day.

[Pantx]

I have nothing to add to Dr Mathur's excellent advice except to have the doc test anti-ccp when testing RA factor. Its a newer more specific test for RA rule out.

[Dr. Kokil Mathur]

Hi!
I am sorry to hear about your medical problems. Well CRP is only a marker of inflammation, and a value above 3 is indicative of heart problems, infection, inflammation, dental problem, arthritis, cancers etc.
If ESR, CRP and ANA are high, then rheumatoid factor should be done to rule out rheumatoid arthritis. Otherwise antibodies to various autoimmune disorders should eb looked into. In your case antiscleroderma-70 antibodies were positive which are indicative of systemic scleroderma or CREST syndrome. The diagnosis may be confirmed if you have symptoms like cold hands and legs or bluish discoloration in them or thickening of skin etc—so since you do not have symptoms, this has been ruled out. A high CRP, ESR and positive MRI of sacro-iliac joint is seen in ankylosing spondylitis.
Since you have high BP and your heart tests are normal (EKG, ECHO, treadmill or stress test, cardiac enzymes—were they all done?) then kidney function should be assessed to find out if there is a kidney problem causing high BP. Similarly liver function and cholesterol should be assessed.
Other than this, it can be fibromyalgia and chronic fatigue syndrome, which is common in people inflicted mono. Antiviral therapy is known to reduce the fatigue and other symptoms. You can discuss this with your doctor. Apart from this maintaining a healthy life style, drinking plenty of water (8-10 glasses per day unless contraindicated due to kidney problems), eating plenty of fresh fruits and vegetables etc helps combat the fatigue and pain. Exercising regularly also helps build strength and endurance. Do discuss this with your doctor. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.