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Lung nodule, heart regurgitation, joint pain
Hi doctor,
I'm a 29 year old female. I have a history of childhood and allergic asthma, was diagnosed with GERD in 2007, and had my right ovary removed in 2009 due to cysts. I have been taking Trazadone and Celexa for several years and more recently, Protonix, for stomach pain/ possible ulcer. I am also using Aldera for an outbreak (first time) of genital warts.
I went to my doctor several weeks ago complaining of severe lower abdominal cramping, epigastric pain after eating and pain in my upper right quandrant. No change in bowels I had a CT with contrast performed of my abdomen and pelvis. Everything looked ok, except for a nodule showed up in the lower portion of my lung. I am being sent for a CT of my chest to see if there are more nodules. I have not smoked a single time in my life. I was also diagnosed with mild mitral and tricuspid regurgitation before surgery on my ovary. I also have joint pain, small sores in my mouth and vagina and sometimes sores inside my nose.
I have been tested for HIV, Herpes, Syphillis, and other STDs. I have mild thrombocytopenia, slightly elevated lipase, and a low positive (1:80) ANA titer with a nuclearor pattern. My RF factor, Sed rate, and CRP have been normal. I was also tested for Celiac, which was normal. Kidney and liver functions are normal. Stool tested for fat, but normal. BUN/ creatinine ratio was slightly high, but both numbers independently were normal.
So the symptom rundown is:
GERD, epigastric pain and lower abdominal cramping
Joint pain (mostly in hands, fingers, toes, knees)
Genital warts
Vaginal, oral, and nose sores (they heal within a few days)
Heart valve regurgitation
Lung nodule
What could be going on with me?
I'm a 29 year old female. I have a history of childhood and allergic asthma, was diagnosed with GERD in 2007, and had my right ovary removed in 2009 due to cysts. I have been taking Trazadone and Celexa for several years and more recently, Protonix, for stomach pain/ possible ulcer. I am also using Aldera for an outbreak (first time) of genital warts.
I went to my doctor several weeks ago complaining of severe lower abdominal cramping, epigastric pain after eating and pain in my upper right quandrant. No change in bowels I had a CT with contrast performed of my abdomen and pelvis. Everything looked ok, except for a nodule showed up in the lower portion of my lung. I am being sent for a CT of my chest to see if there are more nodules. I have not smoked a single time in my life. I was also diagnosed with mild mitral and tricuspid regurgitation before surgery on my ovary. I also have joint pain, small sores in my mouth and vagina and sometimes sores inside my nose.
I have been tested for HIV, Herpes, Syphillis, and other STDs. I have mild thrombocytopenia, slightly elevated lipase, and a low positive (1:80) ANA titer with a nuclearor pattern. My RF factor, Sed rate, and CRP have been normal. I was also tested for Celiac, which was normal. Kidney and liver functions are normal. Stool tested for fat, but normal. BUN/ creatinine ratio was slightly high, but both numbers independently were normal.
So the symptom rundown is:
GERD, epigastric pain and lower abdominal cramping
Joint pain (mostly in hands, fingers, toes, knees)
Genital warts
Vaginal, oral, and nose sores (they heal within a few days)
Heart valve regurgitation
Lung nodule
What could be going on with me?
Hi doctor. Thank you very much for your detailed answer. I'm awaiting the results from my chest x-ray to determine if this was a SPN. I was concerned about some systemic disease process, like Rheumatoid Arthritis, but all my blood tests have come back normal for that. I also have an appointment with a Gastroenterologist next week. Thanks again for your answer.
Rhonda
Rhonda
MEDICAL PROFESSIONAL
I just saw your note about the nodule size. By all conventional standards, a 3-4 mm nodule is a tiny nodule. The overwhelming percentages of nodules this size are benign.
MEDICAL PROFESSIONAL
Sounds like you do have a lot going on. I assume that you have listed all your meds below. While trazadone, Celexa and Protonix can occasionally cause nausea, to my knowledge “severe abdominal pain” is not a side effect. If you are taking other meds, not listed below, check with your doctor to determine if one of those might be the cause of your pain.
The abdominal cramping, epigastric pain and RUQ pain could be on the basis of a functional bowel disorder but that should not be the assumption, especially with severe, diffuse cramping pain. A vascular problem with reduced blood flow would be unusual in a person your age, in the absence of other signs of an autoimmune disease characterized by vasculitis (inflammation of blood vessels). On the other hand, inflammatory bowel disease, most notably Crohn’s Disease is not age dependent and the characteristic findings of the disease, seen on CT with contrast, might not be evident in the early stages of the disease. Predominantly a disease of small bowel, Crohn’s disease can occasionally also involve the stomach. I suggest that you ask your doctor if he/she and the radiologist who interpreted the CT Scan are 100% certain that the study rules out this disease. The same question should be posed regarding the diagnosis of Celiac Disease, noted by you to have been considered and the “ testing that was normal.” And finally, rare causes of abdominal pain, with conventional testing being negative/normal, should also be considered. Such diseases would include porphyria.
It should be noted that Crohn’s Disease, while primarily a gastrointestinal disease is actually a multi-system inflammatory disease, disorders of the bones and/or joints being one of the most common extraintestinal manifestations. Painful joints occur in up to 20% of persons with this disease and mouth ulcers are not uncommon.
Even without that absolute assurance, consultation with a Gastroenterologist should be seriously considered, especially in the absence of another diagnosis to account for your symptoms.
The “slightly elevated” lipase raises the question of subacute or chronic pancreatitis. That may be ruled out by other tests, including the CT Scan.
Not having the CT Scan of the Chest results, I will assume that the lung nodule is a solitary nodule, is not especially large (< 1” in diameter) and without any features to suggest a malignancy. Given those criteria, such nodules observed as an incidental finding in a non-smoker 29 year old person are almost invariably benign. So, please don’t lose any sleep over the nodule.
I suggest then that further attention be directed to establishing the cause of your abdominal pains, with the assistance of a GI specialist. Also, given the history of recurrent infection described by you, your doctors may want to consider the possibility of a non-HIV immunodeficiency state.
Good luck
The abdominal cramping, epigastric pain and RUQ pain could be on the basis of a functional bowel disorder but that should not be the assumption, especially with severe, diffuse cramping pain. A vascular problem with reduced blood flow would be unusual in a person your age, in the absence of other signs of an autoimmune disease characterized by vasculitis (inflammation of blood vessels). On the other hand, inflammatory bowel disease, most notably Crohn’s Disease is not age dependent and the characteristic findings of the disease, seen on CT with contrast, might not be evident in the early stages of the disease. Predominantly a disease of small bowel, Crohn’s disease can occasionally also involve the stomach. I suggest that you ask your doctor if he/she and the radiologist who interpreted the CT Scan are 100% certain that the study rules out this disease. The same question should be posed regarding the diagnosis of Celiac Disease, noted by you to have been considered and the “ testing that was normal.” And finally, rare causes of abdominal pain, with conventional testing being negative/normal, should also be considered. Such diseases would include porphyria.
It should be noted that Crohn’s Disease, while primarily a gastrointestinal disease is actually a multi-system inflammatory disease, disorders of the bones and/or joints being one of the most common extraintestinal manifestations. Painful joints occur in up to 20% of persons with this disease and mouth ulcers are not uncommon.
Even without that absolute assurance, consultation with a Gastroenterologist should be seriously considered, especially in the absence of another diagnosis to account for your symptoms.
The “slightly elevated” lipase raises the question of subacute or chronic pancreatitis. That may be ruled out by other tests, including the CT Scan.
Not having the CT Scan of the Chest results, I will assume that the lung nodule is a solitary nodule, is not especially large (< 1” in diameter) and without any features to suggest a malignancy. Given those criteria, such nodules observed as an incidental finding in a non-smoker 29 year old person are almost invariably benign. So, please don’t lose any sleep over the nodule.
I suggest then that further attention be directed to establishing the cause of your abdominal pains, with the assistance of a GI specialist. Also, given the history of recurrent infection described by you, your doctors may want to consider the possibility of a non-HIV immunodeficiency state.
Good luck
Wow, no answer yet. Can I have my money back????
I called the office to get more detail. Apparently it is a 3-4 mm nodule.
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