Lymph Node Swelling, Back Pain, and Night Sweats

Lymphatic issues, back pain, and night sweats are concerning problems?

Hello, Doctor.
Since the passing of a family member in October, my previously hectic and stressful life has slowed down, and my body has started to react to the sadness with various symptoms.
Over the past two months, I have been visiting the hospital almost every week, undergoing numerous tests, yet no cause has been found.
My body continues to experience discomfort, leaving me feeling mentally and emotionally tormented, helpless, and fearful.
I would like to ask for your advice on how to identify and improve my current condition.
Thank you!
Symptoms:
1.
Lymphadenopathy: Over the past two months, I have developed 5 or 6 swollen lymph nodes in my neck, mostly around the jawline.
They are warm, painful, movable, and can shrink, but they repeatedly swell up again after a few days.
Each node is under 1 cm, with one larger node in the submandibular triangle measuring 1.5 cm.
2.
Upper back pain: I primarily have pain on the left side that extends to my shoulder and upper arm.
Occasionally, I also experience pain in the right upper shoulder and neck, especially when lying flat at night.
I often wake up sweating and in pain halfway through the night.
Massage provides temporary relief, but the pain returns after about half a day.
3.
Night sweats: Previously occasional, but for the past week, I have been waking up every night drenched in sweat, with noticeable pain in my shoulders and back upon waking.
I'm unsure if this is related.
4.
Mental fatigue: I feel somewhat disoriented and find that I need to rest immediately upon returning home (previously, I could manage for another 5-6 hours).
5.
Sore throat and difficulty swallowing: I have been experiencing recurrent throat pain and swallowing difficulties.
I have sought medical attention and undergone various tests in the following order from early November to now:
1.
Company health check: Gastroscopy, chest X-ray, Helicobacter pylori test, abdominal ultrasound, gynecological ultrasound, thyroid ultrasound, neck ultrasound, breast ultrasound.
Abnormal findings: 0.73 cm thyroid nodule (referred to endocrinology, awaiting biopsy results), suspected lymph nodes or fibrocystic changes in both axillae (referred to rheumatology), mild regurgitation of the mitral and tricuspid valves (the doctor said it's very mild and common, just needs annual follow-up), and a slightly low white blood cell count of 3.9 (subsequent hospital tests showed no abnormalities).
2.
Rheumatology: Seven vials of blood were drawn, including tests for thyroid function, immune-related markers, chest X-ray to rule out tuberculosis, and vitamin D3 (only abnormal result was 15).
The doctor could not find a cause and referred me to an ENT specialist regarding the lymph nodes for possible infection.
3.
ENT: I consulted two different ENT specialists in October and mid-November regarding the lymph node issue.
They reviewed the blood tests from rheumatology and felt that everything that could be done had been done.
They added an EBV blood test (result was negative) and noted that the size, shape, and appearance of my nasopharynx looked fine.
They suggested that my skin issues could be causing the swelling and advised me to rest more, mentioning that being thin makes lymph nodes more palpable (but they are swollen and painful).
4.
Clinic ENT: Due to persistent swelling and pain in the lymph nodes, along with anxiety from not receiving any treatment, I visited a clinic where I was prescribed antibiotics and anti-inflammatory medication for three days, which did not provide significant relief.
5.
Endocrinology: Due to the 0.73 cm nodule found during the health check, I underwent another ultrasound and biopsy, and I am currently anxiously awaiting the results.
This has been my journey over the past two months, and the inability to find a cause has left me exhausted.
Various potential diagnoses keep running through my mind: lymphoma, thyroid cancer, chronic fatigue, autonomic nervous system dysregulation, and I even wonder if I might have health anxiety or if this is all due to trauma and stress.
These uncomfortable symptoms have significantly disrupted my life, and I truly hope to find a treatment soon.
I would like to ask for your further treatment recommendations.
Thank you very much for patiently listening to my symptoms.

Yang, 30~39 year old female. Ask Date: 2023/11/30

Dr. Zheng Jueyi reply Otolaryngology

Hello, currently the cause cannot be determined.
If most tests show no abnormalities, chronic fatigue, autonomic nervous system disorders, or health anxiety may be suspected.
It is recommended to seek evaluation and assessment from a psychosomatic medicine specialist.

Reply Date: 2023/11/30

More Info

I'm sorry to hear about the challenges you're facing with your health, especially following the loss of a loved one. It’s understandable that such a significant emotional event can lead to various physical symptoms, and it seems like you are experiencing a complex interplay of issues, including lymph node swelling, back pain, night sweats, and overall fatigue.

Understanding Your Symptoms
1. Lymph Node Swelling: The lymph nodes in your neck and under your jaw are part of your immune system and can swell in response to infections, inflammation, or other underlying conditions. The fact that they are movable and fluctuate in size is often a good sign, but persistent swelling should not be ignored. Given your recent emotional stress, it’s possible that your body is reacting to this stress, leading to inflammation and lymphadenopathy.

2. Back Pain: Your description of back pain, particularly on the left side, which radiates to your shoulder and arm, could be related to muscle tension or strain, especially if you have been under significant stress. Stress can lead to muscle tightness, which may contribute to pain. Additionally, if you have a history of poor posture or prolonged periods of inactivity, this could exacerbate your discomfort.

3. Night Sweats: Experiencing night sweats can be distressing and may be associated with various factors, including anxiety, hormonal changes, or infections. In your case, the emotional toll from your recent loss could be contributing to these symptoms, as stress and anxiety can disrupt normal sleep patterns and lead to physical manifestations like sweating.

4. Fatigue and Mental Fog: The feelings of fatigue and mental fog you describe are common in individuals experiencing chronic stress or grief. Your body may be in a heightened state of alertness due to emotional distress, which can be exhausting.

5. Throat Pain and Difficulty Swallowing: This could be related to the swollen lymph nodes or could indicate another issue, such as an infection or inflammation in the throat.

Recommendations for Management
1. Consultation with Specialists: Since you have already seen various specialists, it might be beneficial to consider a comprehensive evaluation by a multidisciplinary team, including an internist, a rheumatologist, and possibly a mental health professional. They can help rule out any underlying conditions and provide a holistic approach to your symptoms.

2. Stress Management: Given the emotional toll of your recent loss, incorporating stress management techniques such as mindfulness, meditation, or counseling could be beneficial. Therapy can provide a safe space to process your grief and learn coping strategies.

3. Physical Activity: Engaging in regular physical activity can help alleviate muscle tension, improve mood, and promote better sleep. Even gentle exercises like walking, yoga, or stretching can be beneficial.

4. Sleep Hygiene: Establishing a regular sleep routine and creating a restful environment can help improve your sleep quality. Avoiding screens before bedtime and practicing relaxation techniques may also help.

5. Follow-Up on Medical Tests: It’s crucial to follow up on any pending medical tests, especially regarding the thyroid nodule and any other abnormalities noted in your evaluations. Ensure that you keep your healthcare providers informed about all your symptoms and concerns.

6. Nutrition and Hydration: Maintaining a balanced diet and staying hydrated can support your overall health and immune function. Consider consulting a nutritionist if you feel your diet may be lacking.

Conclusion
Your symptoms are interconnected and may be influenced by both physical and emotional factors. It’s essential to continue seeking medical advice while also addressing the emotional aspects of your health. Remember, it’s okay to ask for help, and taking care of your mental health is just as important as addressing physical symptoms. Please keep your healthcare providers informed about your ongoing symptoms and any changes you experience.

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