Migrating Inflammation

Posted by asindia @akhindia, Sep 22 8:50am

I'm a 33-year-old female with all other health parameters normal. Since August, I've been dealing with a recurring pattern of inflammation, warmth, itching, and pain that keeps appearing in different spots on my right leg only, moving progressively downward over time.

It started on my inner right thigh with inflammation, warmth, and itching, which healed on its own in 2 days without any medication. A second spot about 10cm away on the same thigh followed the same pattern and again resolved in 2 days without treatment. Next it moved to the back of my right calf, with inflammation and pain this time. My doctor suggested taking Amoxicillin three times a day for 7 days along with a painkiller, which reduced the inflammation and pain, though I was left with itching that eventually settled on its own.

After that, it appeared between my right toes (2 and 3), with inflammation and pain severe enough to affect my walking. My doctor suggested Medrol 8mg twice a day for 6 days. It then moved to my right ankle with inflammation and pain, which resolved after a few days but left itching behind. The inflammation and pain then settled around my foot, and the earlier affected areas near the toes have now turned brownish and were itchy. My doctor suggested Albendazole 400mg for 5 days for this, but the symptoms flared up again the following evening.

Currently, the pain has moved up to around my shin bone. It intensifies by evening, and by night I end up limping. Meanwhile, the earlier affected areas near my toes remain brownish.

On the lab front, my IgE levels started at 2200, came down to the 900s, and are now in the 600s. My CRP was 12, dropped to 7, then below 5, and has now gone back up to 16. Ruled out DVT, malarial parasites, and filarial parasites. RA factor is normal.

Every episode has been on the same right leg, moving from thigh to calf to toes to ankle to foot and now the shin, with each spot partially resolving before the next one starts. Antibiotics, steroids, and an antiparasitic have each brought partial relief, but the pattern keeps recurring and migrating, and my CRP jumping back up to 16 after coming down is worrying me.

Has anyone dealt with something like this before — recurring, migrating inflammation and pain along one limb, with fluctuating inflammatory markers? What ended up being the cause or diagnosis for you, and what helped?

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seniormed | @seniormed | Sep 22 11:38am

Possible parasite like Strongyloides from travel.
Stool test and IgG antibody tests if stool does not show it. Any symptoms of stomach or GI. ?You may need a tropical med specialist or derm consult. Take photos to
document.

gently | @gently | Sep 22 6:48pm

In addition to seniormeds good advice other possibilites might be lupus or limes. You might want to see a rheumatologist as well as a tropical med specialist and/or dermatology consultant.
Let us know how you fare.

asindia | @akhindia | Sep 22 8:47pm

In reply to @seniormed "Possible parasite like Strongyloides from travel. Stool test and IgG antibody tests if stool does not..." + (show)

@seniormed Thank you for this direction.

No GI symptoms and no travel history. I haven't had a Strongyloides-specific stool test or IgG antibody test yet — only Albendazole based on clinical suspicion — so I'll get both done. One thing I forgot to mention: my CBC and AEC are both normal. I've been photo-documenting the affected areas.

asindia | @akhindia | Sep 22 9:29pm

In reply to @gently "In addition to seniormeds good advice other possibilites might be lupus or limes. You might want..." + (show)

@gently Thank you so much. I hadn't considered lupus or Lyme, so I appreciate you flagging those as possibilities alongside the parasite angle. I've just given samples for the ANA profile. My RA factor came back negative, which is partly why I hadn't gone to a rheumatologist yet, but I'll consider following up with one based on the ANA results.

kaybast | @kaybast | Sep 25 1:14pm

In reply to @akhindia "@gently Thank you so much. I hadn't considered lupus or Lyme, so I appreciate you flagging..." + (show)

@akhindia hi….my Rheumatologist did a complete work up on me . He found high inflammatory markers in my bones, my blood and my gut. He prescribed a series of infusions of Remicade . However , shortly after , a bacteria , Pseudomonas was found in a sinus culture and a Sputum culture . So my infusion treatments were cancelled . Rimicade depresses to immune system so the meds can go after the inflammatory areas . But by that being done, that allows that bacteria to go to other areas and cause infections … could become very serious . . So I’m in a holding pattern .
I’m scheduled for maxillary surgery week after next and the ENT DR thinks he will eradicate the colonized (resting) bacteria in the sinus area. My Pulmonologist is dealing with the bacteria in my lungs.
It’s a long drawn out affair. I sincerely hope you are able to find some relief. All the best to you ..Kay B.

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