Starting in the late Summer of 2005, I noticed that I was chronically
fatigued. The exhaustion was so bad at times that I could literally
feel it in my bones. My concentration levels dropped, I had trouble
remembering things and sometimes felt like I had a veil over my eyes
because I was so foggy.  I attributed this to both a stressful work
schedule and marathon training. Once the marathon and the difficult
work project ended, I expected to fee noticeably better. Quite the
opposite happened and I continued to feel more and more fatigued. I
continued to do my daily activities, but still felt like I couldn't
concentrate. On top of this, I would occasionally get night sweats and
my stomach was chronically upset. Though I had been diagnosed with IBS
back in 2004, the gas,bloating, diarrhea, constipation had gotten
significantly worse.

I revisited my psychiatrist who had been treating me for anxiety and
depression with great results using a low dose of Effexor (75mg). She
suggested I take a "booster" dose of Wellbutrin (75mg) in case the
Effexor was no longer helping me for depression. I did this and
nothing changed. The fatigue and everything else remained.

I had also visited my PCP who continued to tell me that he didn't
think there was anything wrong with me. Blood test results according
to him were normal. I visited a different doctor in the same practice
who drew my blood in January. According to her, my eosinophils were
elevated (reading of 10.8%). She did a stool specimen (especially
since I had giardia in 2000). The stool test came back negative and
she repeated the blood work. This time, my eosinophils were elevated
to 11.4% and my MCH was elevated to 33.3pg. She sent me to an
allergist who did a battery of tests and found that I had no
detectable allergies of any kind (he did blood work plus a skin prick
test). HOWEVER, he noticed that my IgMs were significantly elevated to
639 mg/dl.

I am being sent for further tests, but no one seems to have the
slightest idea what's going on. Of course, I am fearing the worst
(Hodgkin's Disease being at the forefront of my mind) and would love
some idea as to what might be going on. Any thoughts? Thanks!

A few things, have you have specific T3 and T4 thyroid tests done? 
The regular thyroid function tests sometimes don't always pick up
thyroid problems.  Also, you said you had allergy tests done, what
about lung function or asthma test?  Is it possible that you could
have some sort of parasitic infection?  Have you had any lymph
swellings or a chest xray recently?

Hi,

My TSH was 2.80 mIU/L and my T4, FREE was 1.1 ng/dl. There is nothing
specified for T3 on my tests.

I did not have a lung function or asthma test done. Nor have I had a
chest xray recently. In 2000, I had what my gastroenterologist
characterized at the time as "the worst case of giardia (he) ever
saw." I have had many endoscopies performed since then and a stool
culture done recently all of which came up negative. I still believe
that this could be a possibility regardless. Otherwise, no lymph node
swelling that I've noticed.

Regarding the asthma test, I ran the marathon in November. Not to say
that there's no chance I could have asthma developing, but wouldn't I
have noticed something at that time (difficulty breathing, etc.)?

Firstly, your MSH level is not that high with the normal being in the
range 27-33, with a norm of 30. In regards to the high level of
eosinophils these are present when there is an allergic reaction or a
high level of parasites. With your case history of giaria infection (a
parasite) there may be some chance that this has not been entirely
cleared up. I would be rechecked to ensure that you are free from a
parasitic infection. I would probably rule out something like chronic
fatigue as you do have elevated eosinophils. Hodgkins disease can
easily be ruled out by the doctor by examination of lymph nodes and a
chest x-ray to examine the lymph nodes in your chest. Sorry i cant be
of more help and good luck!!

I have no idea too, but elevated IgM would prompt me to think towards
Waldenstrom macroglobulinemia.

You had mentioned psychiatrist.  In the last 30 days have you been
treated with any antipsychotic drugs, specifically, Fluanxol
(Flupenthixol Decanoate/Flupenthixol Dihydrochloride)?  Eosinophilia
has been specifically reported to coincide with the intake of Fluanxol
and other antiasychotics.

Hi,
Thanks for your comments. In response, I have never been treated with
an anti-psychotic drug of any kind. As I mentioned in my first note, I
have been treated only for depression and anxiety with low doses of
effexor and wellbutrin. In terms of the giardia, I recently had a
stool test which came back negative and have been tested numerous
times since my initial diagnosis using the "gold standard" test of
upper endoscopy. Each time the result has been negative for giardia.
As for Waldenstrom's, I had heard that that was limited to folks in
their 70s. I am in my very early 30s. Don't know if that makes any
difference.
Thanks for all of your thoughts!!

Can be autoimmunity. Prednisolone is used i such cases.

Any facial swelling, or itching? Could possibly be:

: Episodic Angioedema

http://www.madisonsfoundation.org/content/3/1/display.asp?did=629

although it is vey rare !

Dr. John Walker