What could be causing my 16-year-old daughter's upper left back pain and neck lumps?

Question #29515

25 days ago

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What could be causing my 16-year-old daughter's upper left back pain and neck lumps? - #29515

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So I have a 16 year old girl,brought in by her mom.For 1+weeks she’s been having back pain upper left side mostly.It started only when laying down flat but now it’s when she is learning at her desk,standing.She says it fells like someone is tearing her skin appart with a lot of pressure and like an electronic pain.Its worse at night or after working with heands,staing to much at the desk.she demands no recent trauma.I look at her back and there is no evidence of a C or S but one shoulder is higher and on top of the other.The Adam’s test aaa positive on the left side with a hump reviling.Now I took vitals mostly normal but I am still thinking about 96-97% oxygen on room air not getting higher and fever is 37,3 that she says she always has this low grade fever . ->Now everyone would think scoliosis including me but she mentioned some lumps in her neck.The first one appeared like 10+months ago and month by month they appeared one by one and now they are 5.They are not moving,rubbery-hard,no pain,1-2cm ,she says they are growing in number not as much as in size. She gained some weight but this past week she lost 2-4 kg,no appetite,latargic,dizzy. Constant infections(kidneys,bladder)that always need I v antibiotics. Gastritis,Lactose intolerance symptoms. Last ultrasound showed hepatomegaly.

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Doctors' responses

Dr. Shayeque Reza

I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.

25 days ago

This is a concerning clinical picture that goes beyond simple scoliosis: while the positive Adam’s test and asymmetry suggest a spinal issue, the combination of progressively enlarging, non-tender cervical lymph nodes (1–2 cm), weight loss, fatigue, low appetite, recurrent infections requiring IV antibiotics, and hepatomegaly raises red flags for a systemic condition, particularly something like Lymphoma or another chronic inflammatory/immune disorder. The described “tearing/electric” back pain could be musculoskeletal, but in this context it should not be assumed benign without further evaluation. This patient requires urgent comprehensive workup, including blood tests (CBC with differential, ESR/CRP, LDH), imaging (chest X-ray/CT), and most importantly lymph node evaluation (biopsy) to rule out serious causes. While not every case turns out to be cancer, these combined symptoms are not typical for isolated scoliosis and should be treated as potentially serious until proven otherwise.

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Dr. Bharat Joshi

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

25 days ago

Hello dear
See as per clinical history
It seems scoliosis but differential diagnosis includes
Tuberculosis
Lymphoma
There is presence of
Fever high grade
Lumps
Infection
Back involvement
Iam suggesting some tests for confirmation of exact diagnosis and best treatment
Please share the result with general physician medicine for better clarity and for safety please donot take any medication without consulting the concerned physician
Crp
Esr
Cbc
Hemogram
Tuberculin test
Ct scan
MRI
Culture
Fnac
Hopefully you recover soon
Regards

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Dr. Nikhil Chauhan

I am currently working as a urologist and kidney transplant surgeon at Graphic Era Medical College & Hospital, Dehradun. It's a role that keeps me on my toes, honestly. I handle a pretty wide range of urology cases—stones, prostate issues, urinary tract obstructions, infections, you name it. Some are straightforward, others way more complex than you expect at first glance. Every patient walks in with a different story and that’s what keeps the work real for me. Kidney transplant surgery, though, that’s a whole different zone. You’re not just working on anatomy—you’re dealing with timelines, matching, medications, family dynamics, emotional pressure... and yeah, very precise coordination. I’m part of a team that manages the entire transplant process—from evaluation to surgery to post-op care. Not gonna lie, it’s intense. But seeing someone who’s been on dialysis for years finally get a new shot at life—there’s nothing really like that feeling. In the OR, I’m detail-focused. Outside of it, I try to stay accessible—patients don’t always need answers right away, sometimes they just need to feel heard. I believe in walking them through what’s going on rather than just giving reports and instructions. Especially in transplant cases, trust matters. And clear, honest conversation helps build that. Urology itself is such a misunderstood field sometimes. People ignore symptoms for years because it feels “awkward” or they think it’s not serious until it becomes unmanageable. I’ve had patients who came in late just because they were embarassed to talk about urine flow or testicular pain. That’s why I also try to make the space judgment-free—like whatever it is, we’ll figure it out. At the end of the day, whether I’m scrubbing in for surgery or doing OPD rounds, I just want to make sure what I do *actually* helps. That the effort’s not wasted. And yeah, some days are frustrating—some procedures don’t go clean, some recoveries take longer than they should—but I keep showing up, cause the work’s worth doing. Always is.

25 days ago

⚠️ Urgent – This is not just scoliosis. Your daughter needs immediate medical evaluation.
You’ve described a 16-year-old with multiple red flags for a serious systemic illness. Do not assume the back pain is simply from posture or scoliosis.
🚨 Red flags that cannot wait
· Painless, enlarging neck lumps (5 over 10+ months, rubbery-hard, non-mobile) → suspicious for lymphadenopathy (lymphoma, TB, or other serious cause)
· Hepatomegaly (enlarged liver on ultrasound)
· Recurrent kidney/bladder infections requiring IV antibiotics → possible immune deficiency
· Unexplained weight loss (2–4 kg in 1 week), no appetite, lethargy, dizziness
· Low-grade fever (37.3°C) – persistent, considered normal by patient but not truly normal
· Oxygen saturation 96-97% on room air and not rising – borderline but concerning in a teen without lung disease
· Back pain described as “tearing skin apart” with electric quality – could be neuropathic pain from spinal nerve root involvement (e.g., from a mediastinal or spinal mass)
🩺 What could be causing this?
Most likely possibilities (need urgent ruling out):
1. Hodgkin or non-Hodgkin lymphoma – classic triad: painless cervical/supraclavicular lymph nodes, mediastinal mass (can cause back pain, pressure sensation, low oxygen), B symptoms (fever, weight loss, night sweats – though night sweats not mentioned). The “electric pain” and back pain worse at night fit.
2. Tuberculosis (TB) – lymphadenitis (neck lumps), hepatomegaly, recurrent infections, low-grade fever, weight loss.
3. Chronic infection / immune deficiency – given recurrent severe infections, possible underlying immune disorder.
4. Leukemia – less likely but possible with bone pain, lymphadenopathy, hepatomegaly.
5. Scoliosis – likely present (positive Adam’s test, shoulder asymmetry) but may be secondary to pain or muscle spasm from another cause. Do not assume scoliosis explains everything.
✅ What you must do right now
· Do not wait for a routine appointment. Take your daughter to a pediatric emergency department or pediatric hematology/oncology clinic urgently (within 24 hours).
· Bring all records: ultrasound report, any blood work, list of infections and antibiotics used.
· Ask for:
· Complete blood count (CBC) with differential
· Inflammatory markers (ESR, CRP)
· Lactate dehydrogenase (LDH) – often elevated in lymphoma
· Chest X-ray or CT chest (to check for mediastinal mass)
· Neck ultrasound or CT of neck
· TB testing (PPD/IGRA) and HIV screen
· Liver function tests, ferritin
📌 What to tell the ER doctor
“My 16-year-old has 5 painless neck lumps for 10+ months, enlarged liver, recurrent infections needing IV antibiotics, weight loss, fatigue, low-grade fever, and now severe upper left back pain with an electric tearing sensation. Her oxygen saturation is 96-97% on room air. Please rule out lymphoma or other serious illness.”
Do not leave without a full workup. This is not a simple scoliosis case.
Dr Nikhil Chauhan

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Dr. Prasannajeet Singh Shekhawat

I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.

25 days ago

Hello
Thank you for sharing these important details. The combination of multiple persistent, non-tender, rubbery-hard, immobile neck lumps (growing in number over 10+ months), weight loss, loss of appetite, lethargy, dizziness, recurrent infections needing IV antibiotics, and hepatomegaly is concerning.
### What This Could Mean
These symptoms together raise concern for a possible underlying systemic or hematological condition, such as:
- Lymphoproliferative disorder (like lymphoma)
- Chronic infection or immune deficiency
- Less likely, but possible: autoimmune or metabolic disorders
The persistent lymph nodes, systemic symptoms (weight loss, appetite loss, lethargy), and organ enlargement (hepatomegaly) especially point toward something that needs urgent and thorough evaluation.
### What to Do Next
This situation is urgent. Here’s what should be done as soon as possible:
1. Immediate consultation with a pediatric hematologist/oncologist for further evaluation.
2. Blood tests: CBC with differential, ESR/CRP, LDH, liver and kidney function tests, peripheral smear.
3. Repeat ultrasound or CT scan of neck, chest, and abdomen to assess lymph nodes and organs.
4. Possible lymph node biopsy to determine the cause.
### Why This Is Important
Early diagnosis is crucial for the best outcome, especially if this is a lymphoproliferative disorder or immune deficiency. The recurrent infections and organ involvement make it important not to delay.
Thank you

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Dr. Arsha K Isac

I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.

25 days ago

Hello
This situation needs prompt medical evaluation because the combination of persistent neck lumps, weight loss, fatigue, recurrent infections, and an enlarged liver suggests more than a simple spine problem like scoliosis.
Possible causes include chronic infection, an inflammatory or autoimmune condition, or a blood or lymphatic system disorder.
The back pain and positive Adam’s test may indicate scoliosis, but that alone would not explain the systemic symptoms.
🛑She should be assessed by a pediatrician or at a hospital within the next few days, sooner if symptoms worsen, fever rises, breathing changes, or pain becomes severe.

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Dr. Aarav Deshmukh

I am a general physician with 8 years of practice, mostly in urban clinics and semi-rural setups. I began working right after MBBS in a govt hospital in Kerala, and wow — first few months were chaotic, not gonna lie. Since then, I’ve seen 1000s of patients with all kinds of cases — fevers, uncontrolled diabetes, asthma, infections, you name it. I usually work with working-class patients, and that changed how I treat — people don’t always have time or money for fancy tests, so I focus on smart clinical diagnosis and practical treatment. Over time, I’ve developed an interest in preventive care — like helping young adults with early metabolic issues. I also counsel a lot on diet, sleep, and stress — more than half the problems start there anyway. I did a certification in evidence-based practice last year, and I keep learning stuff online. I’m not perfect (nobody is), but I care. I show up, I listen, I adjust when I’m wrong. Every patient needs something slightly different. That’s what keeps this work alive for me.

23 days ago

Considering your daughter’s symptoms, there are a few aspects that warrant careful consideration. The description of upper left back pain, especially with associated symptoms of asymmetry in the shoulders and a positive Adam’s test, indeed raises the possibility of scoliosis. However, the pain characteristics you describe, such as ‘tearing’ and ‘electronic’, could potentially suggest neuropathic pain, which might be related to the spinal alignment or another process affecting the nerves. The presence of neck lumps that are rubbery-hard and non-mobile, combined with systemic symptoms like weight loss, loss of appetite, lethargy, dizziness, and a history of constant infections, suggest the need for a more extensive evaluation for potential lymphoproliferative disorders, like lymphoma. It’s also notable that the lumps have been increasing in number, which merits further investigation.
The hepatomegaly detected on ultrasound, coupled with ongoing infections, and gastrointestinal symptoms might indicate an underlying systemic issue. Given her complex symptomatology, further testing could include blood work to check for hematologic abnormalities, inflammatory markers, and liver function tests. Imaging studies such as a CT scan of the neck and chest might be advisable to assess the lymph nodes more clearly. Given the potential seriousness associated with these symptoms, it’s crucial to refer her to a specialist, possibly a hematologist or oncologist, for a more comprehensive examination and to rule out any serious underlying conditions. Prioritize scheduling this evaluation promptly to determine the next steps in accurate diagnosis and management.

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