Coughing Up Blood

[jlstarnes71]

I'm a 38 year old male, non-smoker  who has been in good shape all of my life.  My family and I recently moved to Indonesia, and since coming here I've dealt with the typical sicknesses as your body adjusts to the new environment.  I also came down with a pretty severe chest cold about a month and a half ago.  Through it all I've lost about 16 lbs since arriving.  2 weeks ago, after working out, I began couging severly for about 30 seconds.  After it ended I began couging up a small about of blood.  In all it probably measured up to almost a tablespoon, and then ended.  The next morning my chest felt like someone had hit me with a baseball bat, but could have been from working out.  I went to the doctor the following day and he listened to my lungs, did the normal pushing of my stomach, checked ear, nose, and throat, and ran some blood tests.  He did not do a chest x-ray, and didn't seem interested in doing one.  He said the lungs sounded clear?  The blood tests came back clear, and the doctor said that I was probably dealing with the tail end of a viral infection.  Then Monday night, after swimming laps in the pool, I started couging again, and up came some more blood.  Again, not a lot, but enough to cause me to be concerned.  My chest is also very sore, but again I was swimming laps and it was the first time I had really worked out since arriving in April.  I've also noticed this morning (Wednesday) that after talking on the phone for an extended period of time that my arms and legs feel a bit tingley and my breathing feels like I have a chest cold again.  No coughing, just breathing doesn't seem quite right.  My color seems to be normal.  I've got another appointment with a doctor tomorrow morning Thursday, but was wondering if I could get some advice.

[J.M. Keyes, MD]

Hi there,
It is certainly possibly that this is a viral infection- that would be the most common cause, but the coughing up blood and weight loss makes this more concerning to me.
I am not familiar with the rates of tuberculosis in Indonesia, but I think you should ask your doctor about this possiblity.  You should have a chest xray and a TB test, in my opinion.  
Sometimes with excessive coughing you can tear a small blood vessel and cough up some blood, so it may be that your symptoms are nothing to be concerned about, but certainly I would want to rule out any serious causes first, especially with the weight loss.  I think at least a chest xray is warranted, and further testing if things worsen or don't resolve soon.

best of luck,
JMK MD