Pain in Extremities With Rash and Eosinophilia H/O Alcoholism

Q; I’m inquiring about my mother’s medical issues. She is 56 years old. She had struggled with alcoholism recently, and was hospitalized a few times from complications. She has been sober for approximately 8-9 months. The doctors said that her liver and blood tests show that she is near normal. She was overweight when she was drinking, but since she has been sober she has lost over 70 lbs and is back to a healthy weight.

However, she is experiencing waning and waxing joint pains, mostly in her arms, finger and legs. She complains quite a bit about pain and numbness in her extremities. At first her doctors told her that she had neuropathy due to the alcoholism, but the drug therapy for that did not abate any of those symptoms. She feels great some days and is able to be active and accomplish daily tasks. Other days she experiences great pain and can barely get out of bed. Her current doctor keeps pushing the neuropathy drugs which she has been taking for several months.

She has a variety of other strange symptoms as well. These include reoccurring blisters and flaking rash on her left hand ring finger for several months. Recent blood work has shown that she has high eosinophil counts. We are at a loss as to what to do next. She feels miserable on her bad days. Do you have any ideas? Would you recommend seeing a specialist for rheumatology or neurology etc.?

Reply:

Though it can very well be an alcohol related neuropathy and some degree of myopathy, other causes definitely need to be ruled out.

The overall picture you gave makes it necessary to rule out the presence of autoimmune diseases, like dermatomyositis, Sjogren’s syndrome, reactive arthritis and others.

An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. This response is a hypersensitivity reaction similar to the response in allergic conditions.

An autoimmune disorder may affect one or more organ or tissue types. Organs and tissues commonly affected by autoimmune disorders include:

  • Blood vessels
  • Connective tissues
  • Endocrine glands such as the thyroid or pancreas
  • Joints
  • Muscles
  • Red blood cells
  • Skin

For this you need to see a rheumatologist. He will examine your mother and get some blood work done. Test for the presence of certain specific antibodies in blood is done. They include:

  • Antinuclear antibody tests (ANA)
  • Autoantibody tests
  • CBC
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)
Also get her tested for the presence of any thyroid problem. Thyroid disorders are common in this age group and may give a similar picture.
Take Care,
Buddy M.D.