more questions about symptoms

[wilkat]

In a recent post you said that my chest CT scans showing small migrating areas of possible fibrosis, bronchial wall thickening, purulent secretions, and elevated IgG were suggestive of  allergic bronchopulomary mycosis or another inflammatory process.  These were all done before 2003.  For several years before that I had periodically coughed up globs of dark brown mucus and had flu like symptoms.  I also had an ethmoidectomy done in 1999.  I had the bronchocoscopy in 2003 but my lung bled and the doctor only got 3 biopsies; lavage was negative.  I had been on 10 mg. Prednisone/day for 4 months when this was done. The doctor that did this said that it could possibly be from GERD which  I do have  and currently take 4 nexiums a day,  but have been to 3 GI doctors who say this is not causing my symptoms.  I went back on prednisone in the fall of 2003 for another 4 months because I started coughing up clear sticky-whitish mucus and it was also draining from my sinuse. I did fairly well until I started tapering off in the winter of 2004 and also got terrible burning pain and tightness in my chest.  I haven’t coughed up much in over a year, but still get the sinus drainage and chest tightness.  I was diagnosed recently with osteitis of the ethmoids. I haven’t had another chest CT scan since Feb. of 2004 when I was tapering off the prednisone again (it was normal) and haven’t been back on it.  

I recently got results from another PF test that shows an FEV1 of 2.10  84%, FVC  2.10  68% and FEV%/FVC  124% and interpretation says mild restriction.  I don’t know where to turn next.  I  still get flu-like symptoms with aching.  Should I get another evaluation for the GERD?  Is Hypersensitivity Pneumonitis a possibility?  Should I pursue the osteitis more aggressively?  Could this continual sinus drainage be causing all of these symptoms?  Would the lung biopsy you suggested show any of these now that I’m off of prednisone.

[National Jewish]

The combination of sinus and lung disease is also seen in various types of pulmonary vasculitis.  This could be suppressed by prednisone, even with the CT scan of the lungs returning to normal.



Your PFTs definitely show the findings of restrictive lung disease.  A normal chest x-ray would not necessarily mean you do not have significant lung disease.  You should have another CT scan.  Talk about the findings with your pulmonary specialist before considering an open lung biopsy.  To be sure of the diagnosis a biopsy will most likely be needed.  However it may be possible to tell from a sinus mucosal biopsy.  Hypersensitivity pneumonitis remains a possibility.  A number of interstitial allergic and non-allergic lung diseases are also possibilities.



Good luck.  Please give us a follow-up.

[HappyNeige]

Sounds complicated.  ABPM (allergic bronchopulmonary mycosis) is certainly a diagnostic possibility.  What's odd about this is you don't have obstruction on your lung function test.  (Obviously, you could expel the entire functional vital capacity within one second. (FVC = FEV1)  People with significant airflow obstruction cannot do that.)



If all the test results are credible, we are discussing a restrictive pulmonary disorder that causes off-and-on inflammation of the lung tissue, a bit of bronchial inflammation and recurrent sinus infection.   Pulmonary vasculitis syndromes, e.g. Wegener's granulomatosis and Churg-Strauss syndrome, would fit these description.  You should at least have a blood test (ANCA) done, if not biopsy of the sinus +/- the lung for a definitive diagnosis.



A few other things also come to mind, i.e. primary ciliary dyskinesia and certain immunodeficiency states, in particular immunoglobulin deficiency.  However, these disorders are usually associated with obstruction on the lung function test.



Severe gastroesophageal reflux disease can lead to recurrent aspiration pneumonia but I find it difficult to tie it to the sinus problems.



In summary, this is a complicated presentation and part of the picture has been modified by intermittent steroid treatments.  I'd suggest that you work closely with your doctor and discuss with him/her about the possibility of pulmonary vasculitis and the role of sinus/lung biopsy to find out what you have for certain.  Hope this helps.



Good luck,

HappyNeige...