Possible Wegener's

[JDS2805]

I'm not sure if this is the right place to ask this question. I will try and not make this too long winded. Over the last 15 months I've had a lot of sinus trouble- mostly from working in a bad environment- however since my work closed down, I've only had 1 or 2 sinus flare ups in the last 6 months. I was suppose to have sinus surgery but my insurance wouldn't cover it- and we couldn't afford to pay for the surgery ourselves. I was recently diagnosed with pericarditis. It was most likely viral because all the tests I had- Chest X-Ray, CT Chest Scan, Stress Test, extensive blood tests were all normal- of course the echo showed the pericarditis and it caused the EKG to be abnormal- a friend of mine who's a PA said I should ask about Wegeners. But I haven't been able to see my family doctor in awhile because he's understaffed- I saw the nurse practitioner and she'd never even heard of Wegeners. I did some research on it and it seems there is no spot on test for it. But it appears to affect either the sinuses, the lungs or the kidneys. With a clear CT scan, chest x ray, and normal blood work- it seems the lungs and kidneys are okay. I'm not coughing up blood, no nosebleeds, no weight loss. I've had consistant fatigue the last year and I've never had a huge appetite. I know this is a rare disease but with the past sinus problems and the constant fatigue, should I ask my doctor to run some more tests to rule this out? I know pericarditis can cause fatigue but I was dealing with fatigue before the pericarditis diagnosis. The only other thing I can think of is Chronic Fatigue Syndrome. Right now I just want answers. Because aside from slightly elevated bilirubin-Gilberts Syndrome, all of my bloodwork has been perfectly normal. I eat right, I get plenty of sleep and I exercise regularly but something is making me fatigue and I just want to know what it is. Is Wegeners a possibility?

[JDS2805]

Thank you very much for the answer! Yes, I had my thyroid tested about a year ago, I'm not anemic, and I had mono back in 2006. I suppose depression could be possible- I haven't been able to find work so money has been really tight with only one pay check coming in. I will look into the sinus surgery again- we are getting new insurance starting tomorrow and hopefully this insurance will at least help pay for a surgery. Thanks again for the answer, doctor!

[Jigisha S. Amin, MD]

We learn in medical school that when we hear hoofbeats, we think of horses, not zebras - meaning common things happen commonly.  Wegener's Granulomatosis is a rare disorder that requires treatment with immunosuppressive therapy and all the side effects of that type of therapy.  It is diagnosed with a biopsy of the lung (if the CT scan is abnormal), or the kidney (if the UA has blood), or the sinuses.  The diagnosis can be supported with a positive ANCA blood test.

We start to suspect Wegener's when the sinus issues don't respond to the usual treatment.  It is more likely that you have chronic sinusitis, made worse by the work envirornment and better by avoidance.  It would be good for you to have the sinus surgery and see if it helps the fatigue.

I'm sure your doctor has also done tests to rule out other common causes of fatigue including low thyroid, anemia, depression and mononucleosis?