Cellulitis or Another Condition?
Patient Profile: M31, height 5’10”, weight 155 lbs. To summarize briefly, I experienced flu-like symptoms for an entire week, culminating in a night of intense sweating and debilitating pain in my armpits. Accompanying this was a noticeable red rash and swollen lymph nodes. I sought medical attention at the emergency room, where the doctors diagnosed me with cellulitis. They prescribed doxycycline, and remarkably, the rash disappeared within a day. However, three weeks have now passed, and I still have seven swollen lymph nodes as confirmed by an ultrasound. The discomfort from these nodes has actually made my arm ache. While doxycycline successfully treated the rash, it hasn't resolved the issue with the lymph nodes, leaving me uncertain about whether this is actually cellulitis. Additionally, tests for Lyme disease showed an initial positive result, but later turned negative as I only had one reactive band. I can't help but feel concerned that this might be indicative of lymphoma. The largest lymph nodes measure roughly 2 cm in size and swelled rapidly, coinciding with the appearance of the rash.
Answers (1)
6/22/2025, 5:30:33 PM
OpenHealth AI
It’s completely understandable to feel concerned about your ongoing symptoms, especially after having experienced significant flu-like symptoms and the diagnosis of cellulitis. You’ve described a situation where the initial treatment worked well for your rash, but the persistent swollen lymph nodes and discomfort are causing you anxiety. Let's explore this further.
Main Points:
- Swollen lymph nodes can persist for various reasons after an infection, including cellular response to the initial infection.
- Your discomfort and concern regarding lymphoma are valid, but it’s essential to consider all possible explanations for the swollen lymph nodes.
Explanation:
Swollen lymph nodes may remain enlarged after an infection as the body continues to clear away any remnants of the pathogens or inflammation. Doxycycline effectively treated your cellulitis, which might explain the rapid improvement of the rash, but it could take longer for lymph nodes to return to their normal size due to residual inflammation.
The reactive bands in your Lyme disease test could suggest past exposure rather than an active infection, especially if the initial positive was clarified to be negative with further testing. Given the ongoing symptoms and your concern regarding lymphoma, it’s wise to consider both the effects of the earlier infection and the need for further evaluation.
Next Steps:
- Continue Monitoring Symptoms: Keep an eye on your lymph nodes—note if they change in size, number, or tenderness over the next few weeks.
- Self-Care for Discomfort: Consider gentle stretching and warm compresses on your arm to relieve discomfort from the swollen nodes.
- Document Your Concerns: Keep a symptom diary to track changes in the size of the lymph nodes and any new symptoms that may arise.
- Follow-Up Evaluations: Consult with your doctor about the persistence of enlarged lymph nodes. They may recommend repeat imaging or blood tests for a more definitive diagnosis. Don’t hesitate to share your concerns regarding lymphoma, as they can provide specific insights or tests if needed.
Remember, many conditions can cause swollen lymph nodes, and continued evaluation is the best course to ensure you receive appropriate care. Your concerns are valid, and it’s important to work closely with your healthcare provider to get to the root of the issue. If you have more questions or need further information, feel free to ask.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.