[Question #4263] Persistent swollen lymph nodes

31 months ago
In Feb.’18, I was given a checkup that found my AST/ALT liver enzymes were very high. A follow-up was scheduled a month later. I had just started high intensity workouts. I have read that this can cause a transient increase in liver enzymes. I stopped workouts pending new tests. Just before the new tests, I had a 24-hour attack of diarrhea/stomach pain. New tests showed liver enzymes were normal (also everything else), and Hep A/B/C neg. The same day, I felt a twinge in my right armpit.
The next day (Apr.’18), I was given a Tdap vaccine in my left arm. 4 days later, my lymph nodes in my right armpit, starting where I felt the twinge, and down the back of the arm felt inflamed and painful. This spread to the left armpit. For 2 weeks, I felt feverish but my temp. was always normal—the most abnormal was 96.6°F. I then felt fullness in my neck. Since then, for nearly five months, I feel intermittent fullness or dull aches in my neck/collarbone/behind my ears/armpits, and occasionally malaise, but no fever. My inguinal lymph nodes have always felt normal.
I have had sex with men and women. With men, only a few times, and always protected. Oral not, but never to ejaculation. In Dec., I started seeing a woman who was tested recently. She was my only partner until my symptoms. My last unprotected oral with a man was in Oct/Nov.’17, sex a few months earlier. I never had a rash, or flu-like illness. I know the only way to know is to get tested. But does this sound like it could be HIV?
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago

Welcome to the Forum.  I'll be glad to comment.  Each of the things you describe has a very good alternative explanation- i.e. high intensity exercise and LFT abnormalities, regional lymph node swelling following g DTAP, etc.  Nothing that you mention suggest a specific need to test for HIV.  On the other hand, it sounds like you have had a number of different sexual partners and you do not mention testing for STIs other than hepatitis. Thus, let me suggest that it might be good for you to go for a sexual health check which includes screening for STIs.  This is not an accusation but simply acknowledgement that you have had other partners in the past, that many STIs can occur without symptoms, and that while it is unlikely that you are infected, knowing this based on negative tests will provide a measure of confidence and reassurance.  We routinely recommend this for new relationships and suggest that such testing should include testing for gonorrhea, chlamydia and sometimes, depending on the test performed, tests for trichamonas using  a urine test.  Testing for HIV and syphilis, while far, far less likely can be easily added with a blood test.  We specifically recommend against blood tests for herpes unless you or a partner has a history of the infection as they have relatively frequent false positive test results and can be misleading. In the US confidential testing can be obtained for little cost at health departments.


I hope this comment is helpful.  EWH


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31 months ago
Hi Dr. Hook,

Thank you very much for the answer and the solid advice. Just some lingering followup questions-- because when I google swollen lymph nodes (though I can't actually palpate any, I almost constantly feel fullness in my neck and tightness when I look up or side to side) or pain in lymph nodes for longer than a few weeks, HIV pops up in all of the results, usually in reference to Persistent Generalized Lymphadenopathy. Does what I described sound like the onset of PGL? Is it something so sudden, with such noticeable symptoms? I read PGL usually occurs later, after the acute stage of infection, but can appear anytime. Since my exposures were low risk and far outside the window period, I feel like it is unlikely to be acute, and I was tested for the full panel of STDs about two/two and a half years ago. Does HIV-related PGL sound plausible? I also don't see my symptoms listed as side effects of the Dtap-- do they sound like they could be a result of it?
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Despite its many strengths, a problem with the internet is that a substantial portion of what is there is taken out of context, is out of date or is misinterpreted-a small proportion is also just plain wrong.  Further the filters and algorithms that drive internet searchs  are impacted by things like search volumes and other more difficult to understand, propriety programming.  It is for this reason the HIV pops up so quickly when the net is searched regarding swollen lymph nodes and lymphadenopathy.  Lymph nodes swell in response to inflammation, irrespective of whether it is caused by infections, other inflammatory processes, and even things like cancer.  Because of their role as part of the way our immune system keeps us healthy, swollen lymph nodes are an entirely non-specific finding which need to be interested in the context of a fuller medical history and examination such as might be carried out by a health care professional.  Detection of lymph nodes, as well as interpretation of their significance, is a bit of an art form.  A good physician can usually find swollen lymph nodes somewhere on just about anyone and in the vast majority of cases, they are not of pathological significance.  All of this if further complicated by the fact that the human body is full of lumps, bums and areas of fullness that most of us do not notice or search for unless we are looking for them. 

I provide all of this as background information.  The information you have provided suggests that you are not at particularly high risk for HIV and the swollen lymph nodes you describe are not worrisome to me.  What you describe is not suggestive of the PGL syndrome which was used to help identify persons with possible HIV infection early in the course of the epidemic.  The symptoms you describe are not typically of either HIV nor or vaccination with DTAP.  If they are troublesome, my advice would be to see your PCP and seek his/her assessment. 

Hope this helps.  EWH 
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31 months ago
Hello Dr. Hook, 

As someone who was reading this message board in a state of anxiety, looking for cases like mine, I really would have liked to see how more of the stories turned out. To let you know, and whoever else may read this eventually, I was tested for HIV and it came back negative.

Thanks for your help Dr. Hook.
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Thanks for your feedback.  I understand and agree with you- it is always nice when we know what testing that we recommend or that clients seek turn out.  It adds to our experience and knowledge.  Before I close this thread, I was wondering if you spoke with your own doctor regarding the symptoms you mentioned or the fact that they were not due to HIV was sufficient to allow you to move forward without concern.  EWH
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31 months ago
Glad to help. My GP ran a battery of blood tests, and all came back normal, which discounted lymphoma, and other infections. She also ran thyroid tests which came back normal. She referred me to an ear, nose and throat specialist because of the tightness and fullness in my neck. She also suggested that it may be psychosomatic, though I had symptoms before I had any sort of preoccupation or anxiety. I can't say I'm wholly satisfied, though the exclusion of worst case scenarios was a big relief.
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Thanks so much for the additional information.  As you point out, this sort of information is helpful to others who come to the site for information.

this thread will be now closed so it can be made available to others.  EWH
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