RN baffled by pericarditis dx and suspects neurologic problem

[RN57]

Was diagnosed 6 wks. ago with postviral pericarditis (classic symptoms of sternal, left sided chest pain with inspiration, position changes, low grade fever, on/off neck pain that radiates into left shoulder blade).  ER prescribed Prednisone burst of 40 mg. x 4 days.  Symptoms returned following week and was Rx Colchicine for 1 wk. due to NSAID allergy.  Echo after tx with Prednisone was normal without any signs of effusion.  EKG's, CXR and CT of chest WNL.  Currently back on Colchicine as was told that Prednisone burst caused rebound pericarditis.  Last WBC  (July 30)13.6,  absolute Neutros 9.7 (10 days after Prednisone),  CRP 1.5, ANA negative, RF negative, CRP slightly elevated.  Strange symptoms of on/off (for about 2 days at a time) include left sided tongue pain, left sided sore throat and left sided lymph node tenderness.  I have had one sided tongue pain and throat pain many times in the past which I always attributed to sinus infections and it was never with any type of chest/sternal pain.  Today the pain is more in the back of my neck, shoulder blade and lower left sternal area/rib cage area.  It seems to be deep inside and is not reproduced by pressing on chest/rib cage.  Today I started with shooting pains up the side of my left frontal head area (just in front of ear or side of face) with bending down and certain movements.  In the past 15 yrs. I have also experienced the chest pain symptoms (about 3 times),  but it only lasted 3-4 days and was diagnosed as costrochondritis.  The past symptoms never lasted this long and was never accompanied by fever or the neck/shoulder blade pain.  

My low grade fever continues on and off throughout the day (I rarely take Tylenol as I am trying to find a pattern) and it has never gone over 100.  Chest pain/sternal pain/lower left rib cage pain can change hour to hour with no pattern.  Pain over lower rib cage feels like spasm at times.  Was just sent for infectious disease consult as I have had many viruses this past winter and spring.  Awaiting blood culture results, histoplasmosis and metabolis profile results.  On 7-2-08 had 3rd of Hepatitis B series.  Infectious disease said may need rheumatology consult for autoimmune disorder (have Graves Dx which is under control).  

I wonder if this could have anything to do with Tapazole (meds include Tapazole, Synthroid and now Colchicine), an autoimmune disorder, post Hepatitis B vaccine reaction (called Merck and they have not seen this reported, but their site lists neuralgia and myalgias), parotid/salivary gland problem with nerve involvement, thymus gland problem, etc.  All along I have told the docs that the pain feels like a muscle or nerve and the last few days with radiation into my shoulder, upper left arm, head, etc. I really suspect a neurologic problem.  In June I had a couple of days of neck pain with cracking sounds.  Could I have a cervical neuritis which somehow is causing my symptoms?  I apologize for the length of this, but really am desperate for any suggestions.  

Thank You!  

[RN57]

Thank you for your suggestions.  Yes, I definitely have lupus in my mind and plan on having an rheumatology workup.  Thank you again!

[Lauri8967]

Hi RN -
You know, if I didnt know better, I would think I was on the lupus forum.  I have lupus, and your symptoms sound like lupus to me (of course, Im not a doc).  Some of the Sx you have are not listed in the formal criteria for Dx lupus, but are common sx many lupus patients suffer from: pericarditis, chest pain, chronditis, low grade fever, elevated CRP...As a nurse, Im sure you are familiar with the symptoms you learn about in school or at work, but many of these sympotms only someone with lupus, or a doc who regularly deals with lupus, would think about.  Also, the fact that you - at first - felt better with the prednisone also would indicate this.  
I know you said your ANA was neg, but being on prednisone could have changed that.  Also, there are many lupus patients that have sympotms before their ANA becomes positive, and many whos ANA test go back and forth between neg and pos.
My docs also believe my lupus was misdiagnosed as postviral syndrome, after developing a serious viral pnemonia years ago.
Obviously, this is just my opinion, but maybe you do need to see a rheumie to figure it out?  A negative ANA does not rule out lupus, despite what many docs believe.
I hope you find out what is causing your pain, and you feel better soon.  I just wanted to share my opinion as a person with lupus.
Lauri