update and questions about my daughter

[Raerae336]

A quick recap. . My daughter has had enlarged nodes since June throughout her entire body.  She's tiring more easily and has had about 4 or 5 fevers in the last month but I contributed them to flu season. Herr doctor did labs and I got some of the results yesterday.  Her wbc was in the normal range but had a left shift.  Her liver function came back abnormal.  A test for inflammation came back elevated. The snap test for lymes came back positive but two other tests that tell you how advanced the lymes is came back negative which my doctor has neverseen before so we are waiting on the final for lymes but my doctor said if it was lymes those two other tests are always positive.  So now I wait. .. and im impatient.  If this final lymes is negative she wants me to see a hemocrat specialist at children's.  Any advice?

[Ken_PA]

I'm not well versed in leukemia, but I don't think her counts were ever above what they would normally be for benign conditions. In fact, aside from the cyclical nature, everything seems like normal childhood experience - except for the nodes being enlarged for so long (which doesn't statistically point to cancer anyway).

Here's an interesting quote from Medscape: "Recognize that most children have palpable lymph nodes in the anterior cervical, inguinal, and axillary regions that, if evaluated by adult standards, would qualify as lymphadenopathy. Lymphoid mass steadily increases after birth until age 8-12 years, and undergoes progressive atrophy during puberty."
http://emedicine.medscape.com/article/956340-clinical#a0217

So, kids can be more reactive as their immune systems encounter the world.

Here is a long thread we had here involving poikilocytosis, which ended up as not-cancer:
http://www.medhelp.org/posts/Leukemia--Lymphoma-/Low-neutrophils--high-lymphocytes/show/1807392

[Raerae336]

Thank you. Do you think leukemia is a possibility here? Her labs in June were totally normal this time her neutrophils were high and lymphocytes were low. Her wbc in June was 5 now it's 14.1 which I know is still in the normal range but definitely an increase since June.  Also mentioned was poikolcytosis 1+ which I discovered upon googling means 25% of her RBC are misshapen.  Im worried that she's in the very early stages of cancer or something?  Idk I'm still awaiting more tests and a peripheral smear is one of them.

[Ken_PA]

I'd keep a diary of what symptoms occur, and when they come and then go. That might give clues one day, especially if the timing is regular. Also observe if the node sizes go up and down in concert with other symptoms like fever.

Here's a journal article with a DDX on PFS: http://intranet.emergency.med.ufl.edu/med_students/reading_assignment/14_periodic%20fever,%20aphthous%20stomatitis.pdf

You'll see left shift mentioned there  - which generally means the neuts are being rushed into action.

Painful nodes can lead to scarring, which results in them not going down - but that doesn't seem to apply here.

Cancerous nodes wouldn't likely pop up all over and then just stop growing.

[Raerae336]

The fevers and such I didn't even think as a symptom until you look at everything combined. They are generally low grade and only last s couple days like a normal virus so that's what I assumed it was until now looking back and hearing her labs are abnormal.

[Raerae336]

No they don't bother her at all I just noticed them one day when brushing her hair. If it's lymes I would be relieved because she'll just need a run of antibiotics but I'm more worried about cancers or an autoimmune disease. Her cbc in June was normal no left shift and it'd I remember correctly they checked for lymes then and it was negative.

[Ken_PA]

Hi, from your first post the thing that came to mind was that she might have some Periodic Fever Syndrome - except that you hadn't mentioned fever. But now you do, so that's something you should keep in mind. (They are rare, though.)

Some are genetic, others are not understood well at all, some aren't even classified yet. It's akin to the body reacting as if to an infection, but without an actual infection being present.

Some can result in an autoimmune attack on the liver - of which some can be detected by an ANA test. Did she have an ANA?

Another rare condition is a  cyclical drop in neutrophils, which result in actual infections.

I'd want to get a CBC done right during her next fever to see what cells are high or low then.


Also, Lyme does many mysterious things and there is a lot of controversy over detection and treatment.

Btw, were any of her nodes ever painful or tender?