Ask the Doctor Question:
I was diagnosed with CLL in 2012. In the past two months I have had an infection in my nose (they figured a staph infection) and an injured shoulder. In both cases the lymph glands were close to the problem. For the nose, the lymph gland behind the ear and for the shoulder, the lymph glands under my arm pit swelled and began to ache considerably (enough to keep me awake at night).
I was wondering if those problems (nose and shoulder) could have contributed to the glands swelling enough to cause pain as in a deep ache in the above areas or if that would be totally unrelated to those injuries and just a progression of the CLL? Seems coincidental that the two areas of swelling and aching were in the areas of the infection and injury.
Answer: Swollen lymph nodes that are localized to the area’s closest to the infection can definitely be related. And swollen lymph nodes when they become large enough can potentially cause a great deal of discomfort.
In reading your question, a couple of other bigger things come to mind that are more related to your CLL diagnosis. There might be a concern related more to your CLL causing the repetitive infections versus focusing on the swollen lymph nodes only. In CLL, gradually over long periods of time the immunoglobulin levels in the blood will fall. As they fall, there is an increased risk of repetitive infections or infections that are difficult to get rid of. Infections are one of THE most significant problems for those with CLL.
Without knowing your exact medical history and lab results, it is impossible to provide guidance. But we would suggest the following:
- Make sure you are seeing a CLL expert and have you made them aware of your recurrent bacterial infections (not just a primary doc or urologist). They need to know if you have repetitive infections of ANY kind. This is because there needs to be further investigation immediately into your CLL lab work.
- Have you had your immunoglobulin/antibody levels tested recently to see if you have an antibody deficiency (IgG/IgA, etc.)? You can read more about the importance of this here as it relates to infection in CLL: https://cllsociety.org/2016/12/immunogobulins-and-ivig/
It is a relatively common finding to have antibody deficiency in CLL. The incidence seems to increase with disease duration and is present in up to 85% of patients at some point in the course of their disease. Published guidelines suggest that patients with a history of recurrent bacterial infections combined with a documented failure of antibody production are the ones who should be treated first with antibiotic prophylaxis (daily doses long term, not just for a few days). Then replacement immunoglobulin therapy should be considered for those who suffer with recurring or persistent infections.