Question
I realize this may not be your expertise, but you were the closest I could find.  I awoke early Aug with paralysing pain in my left shoulder. I have since been told subacromial bursitis, then muscle strain, now a flat out I don't know from my Orthopedic. However, after hounding him for some sort of answer, he said maybe viral neuritis, or that it may be systemic. My pain has changed and is now throughout my entire arm down to my fingers. I can barely move my arm without intense pain, and sometimes it hits while perfectly still. I am also experiencing swelling throughout the upper left quadrant of my body. I have chest pains (EKG normal), my face is swelling (and numb on left - this has been a chronic issue, as well as numbing of Left arm down to pinkie and ring fingers). My right knee has swelled with pain up through hip. My whole body is feeling rather stiff these days, especially in morning and after resting.  I have been getting rashes on my L leg, L breast, both hips, L elbow, L armpit - all non-itchy. (they are almost gone now - I don't believe it is Shingles, although I did have shingles on left arm 2 years ago) I have an extremely itchy patch on my L breast (different area than the rash) and left ab, with no visual abnormalities. I've been feeling really unwell the last couple of months, including dizzy spells, a faint feeling, burning sensation on face - it feels like a sunburn (no rash), headaches, shooting pain in my left ear with a feeling of fullness. I keep getting these weird chills (but not cold) up my spine, in my head, and left side of body, regardless of temperature. A couple of weeks ago, I developed a pea-sized lump behind my left knee, no pain, but seems to be enlarging slightly. I have not run a fever, but after a dizzy episode, my temp dropped to 96.4. I raised it by taking a warm bath.. . has not happened since. My night sweats (which began 5 years ago with the KFD) have become drenching, but I have been on different meds. My urine output seems to be very low, but my liquid intake has increased tremedously, again, I have been on diff meds. I have a large lump on L arm, trapezius muscle, many behind shoulder blade, none of which are painful - all thought to be muscle knots, and my L shoulder blade is winging, with my shoulder drooping forward. Some joint fluid has been detected in shoulder through MRI and plain xray.

I have been on narcotic pain killers, antiinflammatories, muscle relaxers, etc. and have gone through a couple of months of physical therapy, which just made things worse. I am basically only using ibuprophin and sometimes Darvocet now just to get by. If I miss a dose, the pain becomes unrelenting. I try to take an epsom salt bath daily also to help releive the pain.  Warmth seems to help, but only at time of application.  I cannot get back in to see a doctor until the end of next month, but am basically starting over with a new Dr.

I do have a five year history of undiagnosed issue, and had been monitored for Lupus (this is due to a previous bout of Kikuchi-Fujimoto), from which I have never recovered fully.  So, a Rheumatological issue may be to blame?

I am female, 36.

Does this sound like viral neuritis, or something else? What can I do about it? What kind of tests should I ask for? What should I ask my new Dr.?

Thank you so much for your time.

Answer
Hi Michelle,

Number one get an infectious disease doctor on your case ASAP. It sounds like a systemic bug to me, and viral. I would also make sure those painless lumps are biopsied since they are painless, (possible cancer). An Ortho is definitely the wrong tool for the job, get a good neurologist or Internist and get a CSF spinal tap culture with a full assay of blood work. Winging of the scapula worries me as well, this can be from nerve supply damage, muscular dystrophy or a pinched nerve. It sounds like you have multiple different causes attacking your immune system at once. This is no easy Dx, you need to see the best doctor you can find. Guillen-Barre Syndrome (unlikely)is also a possibility and a plasma phoresisis will be needed stat. Please get to an ER and get a Neuro and ID (infectious disease) guy to start the work-up.

If you need me to call in the orders to the hospital and write you an order on a script I will, my number is 708-466-9994 and will be available to coordinate your care and see to it this doesn't end up as an exercise in trial and error medicine. Insured or not, this needs follow up immediately!

Good Luck!

Dr. Timothy Durnin