Aa
Diagnosis of Autoimmune Condition
59 year old female initially experienced high fever, severe headaches , chills , cold sweat - unresponsive to antibiotic treatment , referred to specialist of internal medicine after ESR found to be 73. Started Prednisolone 30mg daily , a week later was treated for a urinary tract infection with antibiotics. ANA ANF 1/10 Dilution positive but ANTI DNA 1:10 Dilution negative. Creatinine , SGOT (AST) and (ALT) normal, thyroid function normal, ANCA studies normal After a month of steroid therapy ESR dropped to 10 and symptoms improved somewhat, but still no confirmed diagnosis. She then suffered a chest cold , cough that may be unrelated but was also accompanied by deafness in right ear. The cough, chest cold subsided however the deafness subsided somewhat but a faint deafness remained with tingling and echoing in same ear and now pain in and around the ear. ENT treated with two courses of antibiotics , however no further relief. As her presnisolone dosage was reduced over the course of one month her initial symptoms came back slowly but not as severe and ESR slowly increasing from 10 to 21 to 27 as Presnisolone dosage now reduced to 5mg. Also now experiencing similar symptoms in left ear.
Questions:
* Does the result of all testing and recurrence of symptoms after reduction in steroid therapy sufficient to diagnose an a general autoimmune condition that warrants treatment with methotrexate? This is the next planned course of treatment
*Can the issues with the ear be related to an autoimmune condition and how can this be verified if at all? What tests can be performed to identify the root cause of the ear condition?
*What other tests can be done to make a firmer , more specific diagnosis with regard to the autoimmune condition.
Questions:
* Does the result of all testing and recurrence of symptoms after reduction in steroid therapy sufficient to diagnose an a general autoimmune condition that warrants treatment with methotrexate? This is the next planned course of treatment
*Can the issues with the ear be related to an autoimmune condition and how can this be verified if at all? What tests can be performed to identify the root cause of the ear condition?
*What other tests can be done to make a firmer , more specific diagnosis with regard to the autoimmune condition.
Hi,
When you say do a complete ANA Panel with staining is this the same as the Anti DNA panel? An Anti DNA Panel was done and all negative.
The presence of antiportease 3 antibodies - is this the same as C - ANCA? the pANCA and cANCA was done and both negative.
Only positive tests was the ANA/ANF. Only tests that wasn't done from the ones you indicated is C- reactive; biopsy of blood vessels.
Condition with ear is worsening and thus far multiple visits to two different ENT specialist have only confirmed that there is excessive fluid in the ear with no response to medications. Not sure if this is related to any of the suspected autoimmune condition.
When you say do a complete ANA Panel with staining is this the same as the Anti DNA panel? An Anti DNA Panel was done and all negative.
The presence of antiportease 3 antibodies - is this the same as C - ANCA? the pANCA and cANCA was done and both negative.
Only positive tests was the ANA/ANF. Only tests that wasn't done from the ones you indicated is C- reactive; biopsy of blood vessels.
Condition with ear is worsening and thus far multiple visits to two different ENT specialist have only confirmed that there is excessive fluid in the ear with no response to medications. Not sure if this is related to any of the suspected autoimmune condition.
MEDICAL PROFESSIONAL
Hi!
ESR can be high in simple viral fevers, bacterial infections, typhoid, tuberculosis, cancers, rheumatoid arthritis, lupus, infective endocarditis, etc. Hence apart from ANA panel, C-reactive protein etc. should be done.
Conditions which can cause elevated ESR, CRP and positive pANCA and respond to steroid therapy could be temporal arteritis or giant cell arteritis. This is diagnosed by biopsy of a small part of blood vessel along with test for complements. The other possibility is vasculitis like panarteritis nodosa. This is diagnosed if three of the 11 signs and symptoms are present such as weight loss, nerve involvement, muscle involvement, skin discoloration, kidney involvement, high blood pressure, positive Hepatitis B or C virus etc. Another possibility is Wegener granulomatosis (antiportease 3 antibodies are also positive). Microscopic panarteritis is another possibility is microscopic panarteritis, diagnosed by positive antiportease 3 antibodies, anti myeloperoxidase antibodies, and complements.
A comprehensive investigation is required keeping all the points in mind. Methotrexate should not be started without doing a complete ANA panel with subtypes and staining, testing for rheumatoid arthritis etc. Take care!
The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
ESR can be high in simple viral fevers, bacterial infections, typhoid, tuberculosis, cancers, rheumatoid arthritis, lupus, infective endocarditis, etc. Hence apart from ANA panel, C-reactive protein etc. should be done.
Conditions which can cause elevated ESR, CRP and positive pANCA and respond to steroid therapy could be temporal arteritis or giant cell arteritis. This is diagnosed by biopsy of a small part of blood vessel along with test for complements. The other possibility is vasculitis like panarteritis nodosa. This is diagnosed if three of the 11 signs and symptoms are present such as weight loss, nerve involvement, muscle involvement, skin discoloration, kidney involvement, high blood pressure, positive Hepatitis B or C virus etc. Another possibility is Wegener granulomatosis (antiportease 3 antibodies are also positive). Microscopic panarteritis is another possibility is microscopic panarteritis, diagnosed by positive antiportease 3 antibodies, anti myeloperoxidase antibodies, and complements.
A comprehensive investigation is required keeping all the points in mind. Methotrexate should not be started without doing a complete ANA panel with subtypes and staining, testing for rheumatoid arthritis etc. Take care!
The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
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