Discussions By Condition: I cannot get a diagnosis.

Lung granuloma, occassional severe pain and thyroid nodules!

Posted In: I cannot get a diagnosis. 3 Replies
  • Posted By: CU Writer
  • November 24, 2008
  • 08:35 PM

Ok, so everyone from my wife's internal medicine doctor to her pediatrician parents to the MAYO Clinic of Jacksonville are stumped.

10 months ago my wife had a few days of nasty pleuritic pain. We thought it was a gall bladder problem as it went away. Five months later it comes back. We get it checked out and nothing wrong with the gall bladder. It goes away. One month ago it comes back, on the other side this time, so we go for a CT scan, which reveals lung nodules.

We get a repeat scan and a needle biopsy which shows some of the nodules gone but others popping up; the biopsy rules the nodules to be granulomas. But subsequent stains, bloodwork and skin tests show that the granulomas are not:

histo, blasto, berry, TB, Wegener's, sarcoidosis, other fungal infections or lung cancer

They are 99% sure that the granulomas were true granulomas but they may want to do a full biopsy or even a bone marrow biopsy to be sure. Now they've recently done an ultrasound on her thyroid because she's long had hyperthyroid symptoms, and believe to see some nodules there. Also, lung function tests and heart rate test show her heart rate is slightly elevated at all times and some parts of her lungs don't get enough oxygen.

So, we've got a 23 year old woman with a handful of small lung granulomas, slightly elevated heart rate, thyroid nodules, some areas of her lungs with insufficient oxygen, occasional debilitating plueritic pain that stays for a few days and disappears for months, and oh yeah she's pregnant.

Does anyone have ANY idea what the heck is going on with my wife?

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3 Replies:

  • I would still suspect Sarcoidosis.. I only say this because there is a wide variability in the presentation, and it is a diagnosis of exclusion. They most likely tested for the ACE levels and that is only 75% accurate, so by no means excluding sarcoidosis. There really isn't much else to test except maybe the CD4+ Cell count, but I'm not sure on the details of this.Increased heart rate can be explained by the decrease in blood oxygen as well as hyperthyroidism. The human lung has a lot of reserve capacity, so i would lean toward thyroid.I've heard that Sarcoidosis has been linked to thyroid problems. but it is more common in Women, and so are most thyroid diseases, so its a questionable link. Without Biopsy of the thyroid it would be hard to determine if their was a connection. If it is in fact Sarcoidosis the granulomas in the thyroid can be sarcoidosis, but it's still very unlikely.Sarcoidosis also has no effect on pregnancy or link with pregnancy. In that respect it is good that Histoplasmosis was excluded.
    nckmorris 53 Replies
    • November 25, 2008
    • 03:28 AM
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  • Well my biggest concerns is that there have been cases of Hodgkins showing itself in weird ways and lung granulomas is one of them. But since my wife got tested for Hodgkins and it came up negative, I think the docs are worried that it's NHL and hence the bone marrow biopsy to see if they can find something there. That's my greatest worry too, even though I've never heard of non-Hodgkin's lymphoma expressing itself as calcified lung granulomas.
    CU Writer 1 Replies
    • November 25, 2008
    • 05:12 PM
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  • Two possibilities: TBtularermia Try here: http://en.diagnosispro.com/differential_diagnosis-for/bx-lung-caseating-granuloma/30106-154.html
    aquila 1263 Replies
    • November 25, 2008
    • 08:58 PM
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