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CT of chest reveald emphysema ( moderate). I have seen three Rhuemys and two fo them think I may have lupus. Anti DNA (DS) Ab Qn was 26, ANA direct was positive abnormal, ACE was 86 high, And sed rate has never been over 3, CCP anitbodies were 49 High, h-pylori Negative. Dont see where PPD was done on my tests. CT abdomen was normal one year ago.
Following causes may be considered;
1) Mycobacterial infections2) Medications3) Gastroesophageal reflux disease4) Sleep apnea5) Idiopathic hyperhidrosis6) Autonomic neuropathy7) Carcinoid syndrome.
Investigations needed are;1) a PPD test, peripheral blood film and blood cultures.2) a bone marrow biopsy.4) a 24-hour urine collection for 5-HIAA, metanephrines, and catecholaminesI am not sure what were the reason given for not starting the treatment for Lupus (medications for autoimmune disorders). Many times, the tests for the autoimmune disorders are not classical but with your symptoms and few investigations being abnormal, a trial of anti rheumatic drugs should be given to see the response and if those medications resolve your symptoms. This is called as therapeutic trial and therapeutic diagnosis. This is done when a clear diagnosis is not established and thus treatment of the closest diagnosis is started. If a 6 weeks trial does not cause resolution of the symptoms, you may consider consulting a infectious disease specialist. PPD test is for tuberculosis and mycobacterial infection. Mycobacterial infection has subtle symptoms and again, many times there are no clear investigations to establish the diagnosis. But it can present with your symptoms and raised ESR. PPD test usually is positive and a good indicator of starting the treatment.Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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I dont' like the idea of taking treatment for anything Im not sure I have, until further testing has been performed to rule out infections. My family has a history of cancer and I am afraid to supress the immune system too much. When I use valacyclovir to treat the herpes my kidneys seem to suffer and my eGFR drops to 50. It goes back up when I get of the acyclovir. I dont have GERD or sleep apnea but last year I was feeling really down and sweaty all the time, blood was taken and the only thing it showed was EOS was high at 0.5 antibiotics were given and my symptoms improved for about two months. I am allergic to Flouroquiolones, but it seems to feel like some kind of smoldering infection that never goes away or some kind of virus that isn't running out. Any other ideas? I will have the PPD and blood cultures done ASAP. Also I am not a smoker but I have lately been coughing up some greasy black sputum but my GP didn't wat to take a sputum sample.
Hello,I agree that with a transient improvement with the antibiotic; a low grade chronic infection is the likely possibility and the culture tests (bacterial, viral and fungal ) and PPD are likely to help in the diagnosis. A sputum culture too would be good idea.It is privilege assisting you.Dr. Arun
Thank you very much I will do my best to get in tomorrow and have these tests taken, although my doctor doesnt seem to care for me trying to tell him what tests I want to have done. I sure do appreciate your time and honesty. Have a great week.