Conflicting Diagnoses: Bacteria or Lupus?
Hello everyone, I wanted to share my recent medical experience and seek some insights. **Demographics:** - Gender: Male - Ethnicity: Caucasian - Age: 37 - Tobacco Use: Moderate use of Iqos - Alcohol: Occasionally, about 2 to 3 beers on weekends or every other weekend **Presenting Symptoms:** I am currently experiencing significant facial inflammation accompanied by several pox-like rashes on my hands and the right foot. **Medications:** Currently prescribed antibiotics at a dosage of 500mg once daily for a duration of six days, alongside cortisone and antifungal cream, an antihistamine pill. **Medical History:** Two weeks prior, I experienced mild discomfort in my right Achilles tendon and foot, which has since subsided. About a month ago, I awoke with muscle soreness that dissipated upon movement; however, the discomfort returned, localized to my Achilles tendon. Following a consultation, my physician ordered a uric acid test, which showed a level of 6.5 (normal range up to 7.5). I was provided with over-the-counter medication and a topical cream for treatment. Unfortunately, after completing that course of treatment, I woke up to find my face was very red, and I developed small red bumps resembling pox on my hands and the foot where the cream had been applied. A Rheumatoid Factor test indicated a level of 5.4, within the range of 0 to 14. Most blood test results were satisfactory, although there were some anomalies: a leukocyte count of 3.58 (normal range 4 to 10), 16 monocytes (normal range 1 to 6), and eosinophils at 6 (normal range 1 to 5). An ANA test yielded a result of 13.8 U/ML, with the normal range being 0 to 25. Similarly, my anti-dsDNA level was recorded at 63 IU/ML (normal range 0 to 200). In contrast, my dermatologist has provided a cream and antibiotics, leading to a rapid improvement in the rashes on my face and hands, though the rash persists on my foot. She suspects a bacterial infection could be the cause. **Question for Consideration:** Is it possible that this condition could be lupus? My research indicates that even with ANA and anti-dsDNA test results within normal ranges, lupus could still be a consideration, as the ideal values should be zero. Any guidance or thoughts on this would be appreciated!
Answers (1)
7/9/2025, 10:40:47 PM
OpenHealth AI
It sounds like you're dealing with a complex situation that has left you with uncertainty about your diagnosis. The symptoms you described—facial inflammation and rashes, alongside your recent medical history—do raise valid concerns regarding both bacterial infections and autoimmune conditions like lupus. Here’s a structured approach to address your concerns:
Main Points:
- Symptoms and Recent Diagnosis: Your facial rashes and inflammation could indicate a bacterial infection, which your dermatologist seems to believe, especially with the positive response to antibiotics. However, the presence of autoimmune markers suggests that conditions like lupus could still be considered.
- Interpreting Lab Results: It's true that test results for ANA and anti-dsDNA can sometimes be present even in healthy individuals, and they do not solely confirm or rule out lupus.
Explanation:
- Bacterial Infection vs. Lupus: It's common for skin issues to arise from infections, especially when there's rapid improvement with antibiotics, indicating a bacterial cause. Lupus can cause similar symptoms but usually involves more systemic issues and must be diagnosed in context with other clinical factors and tests.
- Autoimmune Markers: Positive ANA or anti-dsDNA tests can suggest lupus but are not definitive on their own. Your levels are indeed low, and the presence of leukocyte and monocyte counts outside the normal range could warrant monitoring but do not confirm lupus.
Next Steps:
- Monitor Rash and Symptoms: Continue using the antibiotics and topical creams as prescribed and observe any changes in your symptoms. If the rash worsens or new symptoms arise, notify your healthcare provider.
- Follow-Up with Healthcare Provider: Schedule a follow-up appointment with your dermatologist or primary care physician to discuss your concerns about lupus and have a thorough evaluation. Bring your test results and symptoms to ensure all information is considered.
- Consider Further Testing: If lupus is still a concern, your doctor might recommend additional tests, such as serum complement levels or anti-Smith antibodies, to gain clearer insights.
- Document Symptoms: Keep a journal of your symptoms, noting any changes or patterns in your rash and other discomforts, which can help guide your healthcare team at your next visit.
Closing Thoughts:
It’s understandable to feel anxious about these conflicting diagnoses. By focusing on monitoring your condition closely and maintaining open communication with your healthcare providers, you will be in a better position to understand and address your health. Do take care of yourself, and feel free to reach out again if you have more questions or concerns!
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