Swollen Lymph Nodes
Aug 13, 2004
Firstly, Thank you for taking the time to provide the valuable service you do to the HIV world. I for one am eternally grateful. My question involves swollen lymph nodes. My labs 4 mths ago showed TCells of 450 and VL of 320. My meds include sustiva, norvir boosted reyataz, epivir, and zerit. I've been postitive since '97. I have a fatty liver. I noticed some pain in my left arm, inner elbow, a few weeks ago. This pain extended down to my fingers, up to my shoulder and behind my back. I found swollen knots in my inner elbow and arm pit. I went to my ID Dr. and he tested my white blood count as he deemed the knots swollen lymph nodes and he said it was normal. He said I did have thrush and prescribed Nystatin 1 tsp twice daily for 10 days and Diflucan 100mg 30 days. I've never had thrush. The sweling immediately went down but not away. Now, I'm having similar pains in my right arm, elbow. Also, lying on my left side at night can sometimes, no pattern, be painful under the rib cage. When I roll over to my right side the pain immediately subsides. My next labs are in a week. My questions are this: Is the normal white blood cell count good with re: to possible lymphoma? Could these recent antifungals be the cause of lymph node swelling? Could a swollen spleen be the cause of the swelling? Even though the white blood cell count was acceptable should I demand a biopsy? If it isn't some sort of lymphoma what else could it be? Are swollen lymph nodes normal within the HIV community and therefore to be expected? I'm sorry for asking more than one question but I thought I would take advantage of your help while I could. If you can't answer them all please answer some. Again, thank you for your help. It is sincerely appreciated.
Response from Dr. Conway
Swollen lymph nodes are never, strictly speaking, normal. They have an explanation, even if it is the HIV doing it. A normal white blood cell count does not make a lymphoma more or less likely. The feel of the lymph node, the pattern of distribution of the nodes, whether or not your spleen is enlarged, and a number of other factors make a lymphoma more or less likely. I am not sure I see any link of the nodes with the thrush or the antifungals.
The best advice I could give is this. You should talk to your doctor about your concerns, discuss a biopsy and make you understand why he thinks you do (or do not) need a biopsy.
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