Reappraise: Persistent, Sharp Elbow Pain Occurring Every Quarter-Hour, No Reported Injury, Feverish Sensations Indicating Flu Symptoms, Body Temperature at 97.8 Degrees Fahrenheit
A puzzling medical case has emerged, as an individual grapples with a range of unusual symptoms that have left doctors stumped. The individual's body temperature remains lower than normal despite feeling feverish, and they have been experiencing flu-like feelings in their muscles for over a week. Adding to the mystery, their resting heart rate increases after an hour walk, and they experience pain in various parts of their body, including their elbow, forearm, feet, fingers, and head.
Small Fiber Neuropathy (SFN) — a condition characterised by the degeneration of small nerve fibers — could potentially be the culprit. Common causes of SFN include metabolic conditions, immune-mediated disorders, infections and post-infectious states, toxic exposures, vitamin deficiencies, thyroid disorders, genetic variants, connective tissue disorders, and idiopathic cases where no cause is found.
Diagnosing SFN requires a combination of clinical evaluation and specialized tests. Clinical assessment focuses on sensory complaints such as sharp, burning, tingling, or electric shock-like pain, typically starting in the feet. Skin biopsy with intraepidermal nerve fiber density (IENFD) count is considered the gold standard for confirming SFN by detecting degeneration of small nerve fibers in the skin. Quantitative Sensory Testing (QST) measures sensory thresholds for temperature and pain to evaluate small fiber function, while Quantitative Sudomotor Axon Reflex Test (QSART) evaluates autonomic small fiber function related to sweat gland innervation.
Additional autonomic testing, including thermoregulatory sweat testing, sympathetic skin response testing, cardiovagal testing, and pupillometry, can identify autonomic involvement. Electromyography (EMG) and nerve conduction studies (NCS) are usually included in the workup to distinguish SFN from large fiber neuropathies. Blood tests to evaluate underlying causes such as diabetes, vitamin deficiencies, thyroid function, and autoimmune markers, as well as imaging studies like MRI or CT scans, might be used if structural nerve lesions or other neurological disorders are suspected. Genetic testing may be performed in familial or unusual cases to detect pathogenic variants in sodium channel genes or others.
While no conclusive results or reports from these investigations have been made public as of 2024, the individual's symptoms have shown some temporary relief. Applying 5% lidocaine numbing cream to the elbow and engaging in an hour of vigorous walking have helped alleviate the stabbing pains in the elbow and finger, potentially indicating peripheral neuropathy.
The individual's own recommendation for themselves is to take some more Omega 3 fatty acids and to get an hour-long walk. The doctor's suggestion of central sensitization is worth considering, as it refers to a state where the nervous system becomes overly sensitive to pain signals. It is important to note that some healthcare providers may be misclassifying or overlooking Lyme neuroborreliosis cases due to diagnostic challenges and misclassification.
In the quest for answers, it is crucial to maintain a proactive and persistent approach, seeking second opinions, asking about tests to rule out underlying conditions, and exploring pain management options for symptom relief. As Willy Burgdorfer discovered the bacterium Borrelia burgdorferi in 1981 while studying ticks for Rocky Mountain spotted fever, the potential link to Lyme arthritis and neuroborreliosis should not be overlooked. An investigation into possible biolab involvement in tick weaponization was initiated in 2019 due to claims made in Kris Newby's book "Bitten".
Ultimately, it is essential to approach this complex medical case with patience and perseverance, seeking out the best possible care and staying informed about the latest developments in SFN research.
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