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!
Related Questions
24M | Unexplained Fainting Incident
**Note:** I previously shared this story, but it was inexplicably removed. I’m a 24-year-old male without any medical diagnosis or prescription medications. While I do consume alcohol occasionally, I hadn’t been drinking before this happened. Around 3 a.m., I got up from bed to use the restroom. As soon as I began to urinate, I suddenly felt a wave of dizziness. The next moment I was aware of was regaining consciousness in the bathtub, startled awake by the sensation of something dripping on me—only to discover it was my own blood. This was my first experience with fainting. When I came to, confusion set in. I was disoriented and couldn’t comprehend why I was being dripped on while in what I thought was my “bed.” Strangely, I also imagined that I was lying on a collection of marbles (which I actually don’t own)—this turned out to be the shattered glass of my shower door lying around me. I’m uncertain whether I lost consciousness first and then fell, or if the fall caused my brief blackout. It took me a few moments to understand why I was in the bathroom at all. I’m not sure how long I was out; I only remember it was around 3 in the morning when I initially got up, and about the same time when I regained consciousness. I dialed 911, and the ambulance arrived promptly. They checked my vitals, performed an EKG and measured my blood sugar, finding nothing unusual. At the emergency room, they repeated the vital checks, conducted a CT scan, drew blood, and took x-rays—yet still no abnormalities were detected. I had several cuts on my face and left arm (curiously, this is the arm that would have been turned away from the door), along with bruising around my ribs. Since the incident, I’ve been suffering from headaches and pain in my ribs. I received stitches on both my face and arm. The nurse suggested I could have stronger pain relief, but I opted for just Toradol. They eventually discharged me, stating, "We’re unsure what caused this, but return if it happens again." What might have triggered such an incident? How can I safeguard against it reoccurring if they remain uncertain about the cause?
Swelling Beneath My Chin Near the Jawline
18-Year-Old Male: I'm reaching out to any medical professionals who might provide insights into my situation. I've been using marijuana since I was 14, but now, at 17, I'm making an effort to stop and have been clean for 18 days. Recently, I've discovered an unusual swelling located just beneath my chin, behind my jaw. It causes some discomfort when I move, yet it doesn’t feel painful continuously. I'm somewhat anxious that this could be indicative of a more serious issue, especially considering it's positioned near my chin's lymph nodes. Any advice or information would be greatly appreciated as it might help alleviate my worry.
Challenges with Appetite and Discomfort While Eating — Difficulty in Gaining Weight
As an 18-year-old male, I find that I become satisfied after consuming rather minimal amounts of food. This situation presents a considerable challenge, particularly since I only need to have a standard breakfast, lunch, or dinner to feel completely satiated for the remainder of the day. My goal of increasing my weight has made this issue even more complicated. When I limit myself to one meal per day, I often face weight loss or an uncomfortable sensation of fullness that leaves me feeling sluggish. Opting for two meals makes me feel excessively bloated, distracting me from my daily responsibilities. Moreover, I suffer from an unusual issue with my throat, where almost any food I consume causes discomfort, as detailed in the list below. I have contemplated focusing on having just lunch while continuing my weightlifting regimen to maintain my current weight and gradually build muscle. What advice could you offer? Could there be an underlying cause for these symptoms? Lastly, would it be wise for me to consult a healthcare professional? Foods That Cause Discomfort: Bread, flour, pizza, fruits, sugary or starchy items, seed oils, chips, and essentially everything else. Foods That Are Tolerable: Rice, salads, chicken, fish, and vegetables. Overall Symptoms Include: * Quick satiety after normal meals * Challenges in gaining weight * Bloated and lethargic sensations when consuming more than one meal * Persistent throat sensitivity to a wide variety of foods
Seeking Insights: My Journey with Undiagnosed Neurological Symptoms
Hello everyone, I'm a 34-year-old female grappling with neurological symptoms that first appeared in October, and I’m eager to hear from anyone who might have faced similar challenges. My journey began with unexpected migraines, blurred vision, and an ongoing sensation of being off-balance or intoxicated. Gradually, I began experiencing mainly sensory-related symptoms, such as tingling and burning sensations, feelings of extreme heat and cold, sharp pains radiating in my arms and back, as well as discomfort in my hands and toes, alongside intermittent numbness. I also endure varying degrees of weakness and heaviness in my right side, specifically my arm and leg, although I haven’t suffered complete functional loss. The nature of my symptoms is erratic; they fluctuate rather than consistently deteriorate. An MRI revealed mild, scattered lesions in the white matter, which were deemed nonspecific. Further tests from a lumbar puncture returned normal results, showing no markers of inflammation, and the oligoclonal bands were not present. A thorough range of lab tests yielded no significant findings. After evaluating my case, the neurology team suggested a possible diagnosis of MS and administered a three-day course of intravenous steroids. While I noticed a slight improvement in some sensory pain, my symptoms persist and continue to vary day by day. I still experience headaches and pressure in my head along with episodes of blurred vision, but there have been no new deficits since treatment. I am reaching out to connect with others who have had similar experiences. I would like to learn about the insights or diagnoses you encountered and what treatments proved beneficial (such as those related to migraine disorders, dysautonomia, or sensory neuropathy, for example). If you have navigated a similar path, I would greatly appreciate your sharing your story. Thank you!
Should I Seek Medical Attention for Left Ear Pulsatile Tinnitus?
A 31-year-old woman reports an ongoing issue with pulsatile tinnitus, which she is currently experiencing solely in her left ear. Although she's noticed this condition intermittently before, she hadn’t paid it much mind due to the absence of pain. Recently, however, her curiosity piqued her interest in researching the condition, where she stumbled upon information suggesting it could be serious. Usually, she avoids searching online for health worries, but now she is contemplating whether a visit to the doctor might be warranted. Can anyone advise on the need for a medical evaluation in this case?