cause of shortness of breath

[elb743]

i am a 51 year female with prior diagnosis of hashimotos , idiopathic progessive peripheal neuropathy (presumed autoimmune), ashtma-mild copd-non smoker-,gerd. lpr, and most recently, relapsing polychondritis. i am experiencing exertional sob with some trouble when eating and drinking as well. i have chonsritis asssociated , chest wall pain, right sided. my most recent chest ct reads: 2007
nodes:multiple calcified lymph nodes in retrocaval pretracheal space & in mid & lower right hilumand hilar nodes measuring up to 10 by 6mm.normal nodes in chest. tiny hyperplastic axillary nodes w- extensive fatty repolacement of the hila & measure up to 8mm.
lungs:subpleural reticular density & atelectatic plaques present along posterior wall pluera of both lower lobes w-tiny foci of subplueral airtrapping. exoiration views  show little increase in lung density of dependant lower lobes w-expiration. the > in desnity is around 50-60 HU compared to normal of 150 HU, = or - 50.this indicates global airtrapping. localized regions of airtrapping not prominent. central bronchi show no wall thickening, few tiny globs of mucous along walls of right upper lobe bronchus. no general interstitial diases, no infilatrate, gound glass, or plueral diasease .
my questions are:
is the chondritis (right side) connected to the old granuloma in that side? i have a sensation of inability to clear the mucous on that side only. it is quite uncomfotable,
also have nightime cough, most propababy related  to gerd? the gerd may be related to gastroparesis ( abnormal empying scan)?  i had an ent evaluation that included an endocscope, which showed all the gerd findings,& some thick mucous.
also, h-o sob related to profound iron deficiency ( FERRITIN <1), but i just completed an FE infusion.
also, i have some esophageal dysmotility ( with 1/2 swallows showing weak contratractions) is this possibly bronchiastasis? thank you

[National Jewish Health]

I am aware of no association between Relapsing Polychondritis and calcified pulmonary lymph nodes.  Your nighttime cough could be related either to GERD, to lymph node pressure on a bronchus or the process, presumably obstructive lung disease (asthma/COPD) that has resulted in air-trapping.  The diagnosis of bronchiectasis is unlikely, in the absence of the typical findings of bronchiectasis, on your chest CT-scan.    

You should request complete pulmonary function testing to determine if any of the (presumed) airway obstruction is reversible with bronchodilators, with or without inhaled steroids.

The following statements, relevant to your condition, are taken from Cecil’s Textbook of Medicine.

Patients with relapsing polychondritis frequently have associated coexisting diseases, such as systemic vasculitis, various connective tissue diseases (e.g., RA), , and thyroid disease.

Patients with autoimmune thyroiditis may have other endocrine and nonendocrine autoimmune disorders. It may be a component of the type 2 polyglandular autoimmune syndrome associated with autoimmune adrenal insufficiency and type 1 diabetes mellitus. It is less commonly a component of the type 1 syndrome that includes adrenal insufficiency, hypoparathyroidism, and chronic mucocutaneous candidiasis. Other nonendocrine autoimmune conditions associated with autoimmune thyroiditis include atrophic gastritis, pernicious anemia, systemic sclerosis, Sjügren's syndrome, and vitiligo.

I assume that you have had a thorough evaluation of the “profound iron deficiency”.  If not, you should definitely consult with a Hematologist.  Also, the best specialist to sort out these various problems would be a Rheumatologist and you should seek that consultation, if you have not already done so.

Good luck

[elb743]

thank you for your thoughtful remarks.

i do have sicca as well. i do see a rhematoligust and am taking plaquenil. i have passed the metabolite test, and may start imuaran. my primary thinks it may be a sclerderma process,  because of the esaphogeal dysmotilty, and reynauds, which we are treating with nifidipine. i have a follup [ with the rhematoligst next month.
pulmonarty function test confirm a non reversible obstructive defect.. mild to moderate.advair helps but triggers reflux (gerd and lpr) i sleep with my bed elevated at the head, which helps.  i do see hematolgist regurlary, and i get iron infustions as necessary. my gi has been very thorough, and has recommed a double ballon endoscopy, which i may do in the fall. whatever this may be, in addition to the RP, appears to be system wide. my main concern though is the exertional sob, perisitent low grade fevers and weight loss ( currently 102), and difficulty swallowing. i know asthma patients have greater sensitivity to feelings of sob, but i do not think this is the case with me at this moment.i will google a couple of the terms you mention and will speak to my gp soon. thank you for your time and advice. regards

[elb743]

ok, this will be my last post. sorry to bother. interesting to read about chronic mucocutaneous candidasis. i have recurrent thrush that i treat with trouches. i wonder if childhood histoplasmosis is part of this. i  also had black mold in my workroom which was dealt with by professional mold remediation team. i will ask my gp about this also. that is very helpful. thanks