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Medical Forum / Diseases and Disorders / AIDS / March 2004

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Re: My white cells are decreasing !! help !

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Laurent - lsft - 26 Feb 2004 23:24 GMT
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English (sorry for my approximative translation)
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Hi,

This is a desperate call as I do not know what to do anymore, and I do not
know where to go, who to see.

7 Months ago, my health began to get bad suddenly and declined weeks after
weeks. No reason has been found so far, and even worse, no doctor takes my
story seriously into account mainly because no evidence in blood tests is
found.

It started with a severe diarrhoea (a few days after my return from a trip
to Scotland ). Then I started to feel very weak, to have very weak muscle
tonus. Then came a fatigue and a very important physical exhaust during 2 to
3 weeks. The symptoms that appeared next, gradually increased with time,
including:

- Physiological tiredness (physical activity increases it a little,
phychologic activity does not have any impact).
- Articular/joint pains (from a light pain to the impossibility to make
certain movements) of main joints.
- Frequent diarrhoea.
- Muscular weakness, weak muscular force.
- Intense muscular aches with small movements of the life (eg: to drive
makes my joints painfull).
- cardiac weakness, in sense I feel that my heart is weak (this is not extra
systoles). I even can be waked up at night or I wake up in the morning with
a weakness trembling sensassion.

Physical activity improves my general health state during 1 or 2 days then
alters it during 3 to 5 days (important pains, extreme tiredness). Meals
gives me forces and energy and my state improves just after (1h) then I feel
exhausted for 3 to 4 hours.

The end of the day goes with severe fatigue generally and I feel
'relatively' better just after weak up.
I do approximately 10% of my physical previous activity and my general state
worsens day after day.

Lab tests results are:
- HIV serology negative, Hiv-1 PCR negative.
- B and C Hepatitis negative.
- Lyme serology negative, Western Blot negative.
- Parvovirus, CMG, Treponematose, all negative.
- HBLA 27 negative
- Toxoplasmose:  EBV: found previous old infection (2002) but no
reactivation of the virus.
- Auto immune tests negative.

The blood tests are normal EXCEPT:
- Lower white cells:
Normal value in old tests:  4 to 5 G/L
Value since the beginning of the symptoms:  3.5 then 3 then 2.9 G/L
Values in constant fall: CD3-CD4-CD8 population:
Since beginning CD4=CD8 decreasing from 365 to 300 then to 260 during last
months.

To note:
October 2002:  viral episode following non-protected sexual intercourses,
with fever, adenopathy, various pains June 2003: a few days before the
beginning of my current symptoms:
Tick bite in a forest in Scotland.

I do not have any phychological troubles and was healthy at the time it
cames.

My feeling is that there is a good chance that the problem is infection and
either:
a) I got someting not known difficult to catch with lab blood tests. In that
case, what could be the next step of investigations ?
b)I got something known (hiv, Lyme, ...) but a particular form of it that is
not detected by common tests. Questions: what to do to , and how to make
further specific tests and which one ?

If somebody has an idea or if these descriptions make you think of a case in
particular, tell me, thank you a lot !!!

Laurent

----------------------------------------------------------------------------
-------------------
French
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Bonjour,

Ceci est un appel un peu desespéré car je ne sais plus quoi faire ni ou
aller !

Il y 7 mois mon etat de santé s'est mis brutalement a decliner de semaines
en semaines. Aucune raison n'a encore été trouvée et pire que tout, la
majorité des medecins s'en foutent royalement et me laisse tomber faute de
preuves aux examens effectués.

Cela a debuté par un grosse diahrée (quelques jours apres etre rentré de
voyage d'Ecosse), puis j'ai commencé petit a petit a me sentir faible
musculairement. S'en est suivi une fatigue et un epuisement physique tres
important pendant 2 a 3 semaines. Les symptomes qui sont apparus ensuite ont
graduellement augmentés avec le temps:

- Fatigue physiologique (activité physique l'augmente un peu, activité
phychologique n'a aucun impact)

- Douleurs articulaires (de la petite pointe douleureuse a l'impossibilité
de faire certains mouvements) des grosses articulations.

- Diarhées frequentes.

- Faiblesse musculaire, peu de force musculaire.

- Courbatures intenses au moindre mouvement de la vie de tous les jours (ex:
conduire).

- Faiblesse cardiaque dans le sens ou je sens que mon coeur est faible (ce
ne sont pas des extra systoles). Cela peut me reveiller la nuit ou je me
reveille tremblant de faiblesse au moindre mouvement.

L'activité physique ameliore mon etat general pendant 1 a 2 jours puis
l'altere pendant 3 a 5 jours (douleurs importantes, fatigue extreme)
Les repas me donnent des forces et mon etat s'ameliore juste apres (1h) puis
un epuisement intervient pendant 3h environ.
J'ai plus de force au lever qu'au coucher ou je suis epuisé de ma journée.
Je ne fais plus qu'environ 10% de mon activité physique et mon etat general
empire de jour en jour.

Au niveau examen, voici les resultats:
Serologie HIV negatif, PCR HIV-1 negatif
Serologies Hepatite B et C negatives
Serologie Lyme negative, Western Blot negatif
Serologies Parvovirus, CMG, Treponematose, toutes negatives.
HBLA 27 negatif

Toxoplasmose: Imunisé
EBV (mononucleose): Trace de mon infection en Juin 2002 terminée en Octobre
2002.

Les analyses de sangs sont normales SAUF:
Baisse des globules blancs:
Valeur normale dans d'anciennes analyses : 4 a 5 G/L
Valeur depuis le debut des symptomes: 3.5 puis 3 puis 2.9 G/L
Valeurs en baisse constante des sous population CD3-CD4-CD8:
Depuis le debut CD4=CD8 passant de 365 a 300 puis a 260 au cours des
derniers mois.

Faits remarquables a noter:
Octobre 2002: episode viral suite a relations non protegés, avec fievre,
adenopathies, douleurs diverses
Juin 2003 quelques jours avant le debut de mes symptomes actuels: piqure de
Tique en Foret d'Ecosse.

Voila, personne ne me prend au serieux et je peine de plus en plus pour
vivre tout simplement !

Que faire, ou aller ?

Si quelqu'un a une idée ou si ces descriptions vous font penser a un cas en
particulier, faite moi signe, merci !

Laurent
lsft@free.fr
GMCarter - 27 Feb 2004 10:15 GMT
Well, my first thought also is Lyme disease from the tick bite. Has
your doctor tried a course of antibiotics?? but that would imply an
infection which generally would not result in an ongoing depletion of
both CD4 and CD8 cells.

A thymoma? See below. How is the B cell count? Maybe also low?

George M. Carter

***
Ann Allergy Asthma Immunol. 2003 Nov;91(5):501-5.  Related Articles,
Links  

Severe T- and B-cell immune deficiency associated with malignant
thymoma.

Yel L, Liao O, Lin F, Gupta S.

Division of Basic and Clinical Immunology, Department of Medicine,
University of California, Irvine, California 92697, USA. lyel@uci.edu

BACKGROUND: Immunodeficiency with thymoma syndrome is a rare disorder
that generally occurs after the fourth decade of life. Typically,
thymic tumors are benign, and gradually developing immunodeficiency
consists of hypogammaglobulinemia with low B-cell counts and an
inverted CD4+/CD8+ T-cell ratio due to excessive CD8+ T cells.
OBJECTIVE: To report the case of a 32-year-old, white man with an
invasive malignant thymoma and profound combined T- and B-cell
immunodeficiency associated with a normal CD4+/CD8+ T-cell ratio,
absence of circulating B cells, and infection with an unusual
organism. METHODS: The patient presented with a superior vena cava
syndrome caused by a malignant thymoma. During chemotherapy and
radiotherapy, he experienced recurrent episodes of pulmonary
infections due to Haemophilus influenza and Serratia marcescens and
persistent oral thrush. He was diagnosed as having thymoma and
underwent immunological evaluation. RESULTS: Sixteen months after the
diagnosis of thymoma, the immunological evaluation revealed profound
lymphopenia, eosinopenia, very low counts of both CD4+ T cells and
CD8+ T cells, and a normal CD4+/CD8+ ratio with negative delayed-type
hypersensitivity skin test results. Hypogammaglobulinemia and absent
specific antibody responses were associated with a lack of peripheral
blood CD19+ B cells. Despite treatment with intravenous
immunoglobulin, the patient died of respiratory insufficiency and
sepsis secondary to a chronic pulmonary infection. CONCLUSIONS:
Malignant thymoma may be associated with severe combined
immunodeficiency. A normal CD4+/CD8+ ratio and the absence of
peripheral B cells suggest a bone marrow defect that affects both T
and B cells in the pathogenesis of this syndrome. Comprehensive
immunological evaluation should be performed when thymoma is diagnosed
to initiate an early and effective treatment to prevent
life-threatening complications.

>------------------------------------------------------------------------
>English (sorry for my approximative translation)
[quoted text clipped - 160 lines]
>Laurent
>lsft@free.fr
Laurent - lsft - 01 Mar 2004 07:23 GMT
I have been tested for Lyme twice, it was negative. I even asked for a
western blot test and was interpreted as clerly negative (only IgG Protein
P41 was positive). I asked also for a antibiotics trial but my doctor
refuses as she said she does not know what I have, and that should be stupid
!
I tried myself 15 days of OFLOXACINE 200 mg twice a day with few results
(gingival infection cleaned)
B cell count has not been tested... It that white cells ? Which one are to
be tested ?

Laurent

> Well, my first thought also is Lyme disease from the tick bite. Has
> your doctor tried a course of antibiotics?? but that would imply an
[quoted text clipped - 213 lines]
> >Laurent
> >lsft@free.fr
GMCarter - 01 Mar 2004 12:58 GMT
I think the best bet is to share the abstract with your physician.
Yes, B cells are a white blood cell...in fact, everything that is NOT
a red blood cell (erythrocyte) is, including neutrophils, basophils,
monocytes, T and B cells, etc.

George

>I have been tested for Lyme twice, it was negative. I even asked for a
>western blot test and was interpreted as clerly negative (only IgG Protein
[quoted text clipped - 254 lines]
>> >Laurent
>> >lsft@free.fr
Baby Peanut - 27 Feb 2004 12:50 GMT
> It started with a severe diarrhoea (a few days after my return from a trip
> to Scotland ).

http://www.fda.gov/bbs/topics/CONSUMER/CON00150.html

http://www.cocoonnutrition.org/catalog/page_kiefer.php
 
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