Help..my 6 yr old is getting worse with no diagnosis

[jaidsmom]

I have a 6 yr old who has played sports since age 3. Soccer and long distance runs. NO BREATHING difficulty. 2 months ago she complained of heart palpitations and difficulty breathing. Heart proved fine. One week later she was lethargic and I couldn't get her to wake up. She was breathing heavy and rapid, with difficulty. I took her to hospital. 5 albuterol treatments later she was worse and admited. She continued to drop in her numbers and they had difficulty keeping her pulse oxygen level over 80 on room air with constant albuterol for 12 hours. Finally after BD treatments as used in CF, she coughed up mucous plugs. All symptoms on one side.  Wet cough & wheezing reacurring for past 2 months. Constant advair, mucous comes back, same side. Neg CF test (large healthy kid). Broncoscopy revealed nothing but the mucous. High IGE (300+). PFT before and after albuterol & exercise induced Asthma test..no change. Dr's can't agree on asthma. NO family history.No previous symptoms. She has no history except chronic constipation and some itchy water eyes during allergy season, but never chest cold or breathing problems. Cold with long lasting wet cough for the first time before this episode but appeared to go away ans was completely gone for at least 3 wks before this started.

Any ideas the Doctors seem stumped?

[National Jewish]

Here are some suggestions to check with your daughter’s doctor about.

Mucus plugs can certainly occur with cystic fibrosis (CF).  The "gold standard" or best test to look for CF is called a sweat test.  A chemical is placed on the skin, stimulated with an electrode to trigger sweating, the sweat is collected, and the amount of chloride in the sweat is measured.  A high amount of chloride in the sweat means CF.  Sometimes the newest test is used to find CF.  It is called a nasal potential difference (NPD).  Electrodes are placed inside the nose to measure electrical currents.  High measurements mean CF.

A fungal infection could cause the mucus plugs along with high IgE.  The mucus plugs could be looked at under a microscope for fungal elements called hyphae.  This mucus could also be cultured to identify the specific fungus.

If the mucus and wheezing are always on the same side of the lung, a CT scan may identify if there is a problem with just that one lung.

A pediatric pulmonologist would be the type of specialist to sort all of this out.

[Ellis7]

Has ABPA been considered [allergic bronchopulmonary aspergillosis]? There is a blood test. Link:
http://www.auntminnie.com/ScottWilliamsMD2/Chest/Infect/Fungus/Aspergillus/Aspergillus.htm  Excerpt:
"ABPA is both a type I (IgE) and type III (Antigen/Antibody complex) hypersensitivity reaction to Aspergillus colonizing the bronchial lumens (not the distal airways) which may mimic asthma or chronic bronchitis......................
Approximately 96% of patients with ABPA will have symptoms of asthma (wheezing). Patients may also have flu-like symptoms with fever, malaise, and fatigue. Patients may cough up thick mucous plugs in which hyphal fragments can be demonstrated ..."

[jaidsmom]

She already tested neg for aspergillus. Still looking for an answer.

[Ellis7]

How about GERD [gastro reflux], which can cause lung damage and aspiration pneumonia? See;
http://www.emedicine.com/radio/topic57.htm Excerpts:
" Frequency:  In the US: As many as 45% of healthy individuals experience aspiration,  which usually involves small amounts of saliva, particularly while they sleep at night. However, clinically significant aspiration occurs in less than 4% of  individuals. ............
The consequences of aspiration include bronchial obstruction, infection, and direct chemical destruction of tissues. "