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sheker
@sheker

Posts: 10
Joined: Sep 21, 2018

Lung Nodule, D-Dimer elevation and ANA +VE

Posted by @sheker, Wed, Oct 10 9:28pm

Lung Nodule, D-Dimer elevation and ANA +VE:

Do I have LUPUS?
In June during my India trip left side Ribs pain started when breathing.I returned to US on July 5th and next day I visited primary care, he ordered CMP and X-RAY both are normal.nothing shown in the X-RAY.After 2 weeks I visited primary care again, then he checked EKG, it was normal.In my 3rd visit Primary care ordered bone scan which gave some clue about pleural effusion.After that i visited Pulomonologist, he checked ANA which came +VE,D-Dimer elevated(high).Then Pulomonologist ordered CT scan in which identified a patchy nodule, by this time pain was severe, lots of burping and incomplete yawning. For small burping and yawing back was hurting a lot.

After nodule identified in the lung, doctor put me on LEVOFLOXACIN for one week then pain got controlled.I finished medication on 09/27, after 10 days ribs pain started again. I am 47 yrs old,hypothyroid patient,previously i was diagnosed with Fibromyalgia (since 2010).These things are scaring me and making me sleepless. Need advise.

Chest X-Ray report (07/12/2018)
"PA and lateral chest images. Heart size and contour are normal. Lungs are clear with normal pulmonary vascularity. No pleural effusion, hilar or
mediastinal prominence is evident"

Bone scan report (09/04/2018)
“Mild asymmetric increased uptake in the left posterior hemithorax. Tracer is distribution is otherwise un remarkable”

CT Scan report (09/18/2018)
"As per regular modules identified within the superior segment left lower lobe measuring together an area of 2.4×2.2 cm.Possibly post infectious. Trace loculated left pleural effusion."

ANA TEST and other Lab tests (09/12/2018)
1.ANA SCR, IFA, W/REFL TITER/PATTERN/SJOGREN'S PANEL 1
–SJOGREN'S ANTIBODY (SS-A) –NAGATIVE
— RHEUMATOID FACTOR –NAGATIVE
–SJOGREN'S ANTIBODY (SS-B) –NAGATIVE
–ANA SCREEN, IFA, W/REFL TITER AND PATTERN — POSITIVE
2.ANA SCR,IFA W/REFL TITER/PATTERN/SYSTEMIC SCLEROSIS PANEL 1
— ANA SCREEN, IFA –POSITIVE
— SCL-70 ANTIBODY–NAGATIVE
–CENTROMERE B ANTIBODY–NAGATIVE
–RNA POLYMERASE III AB–NAGATIVE
3.D-DIMER, QUANTITATIVE — 1.35 (should be less than 0.5)
4.ANA SCR,IFA W/REFL TITER/ PATTERN/LUPUS PNL 1
–ANA SCREEN, IFA– POSITIVE
5.ANTINUCLEAR ANTIBODIES TITER AND PATTERN
–ANA PATTERN –Nucleolar
–ANA TITER=1.40 ( should be

REPLY

Hello @sheker, I have no medical training or background to be able to tell you that you have Lupus based on the test results you listed. It's good to ask questions and learn as much as you can about your health issues but the diagnosing part is not something Connect members can do. Hopefully we can help you find the answers. Here are a few discussions that may help you meet other members with similar health issues:

Systemic lupus erythematosus (SLE): https://connect.mayoclinic.org/discussion/systemic-lupus-erythematosus-sle/
Tumid Lupus with SLE Symptoms?: https://connect.mayoclinic.org/discussion/tumid-lupus-with-sle-symptoms/?utm_campaign=search

@kanaazpereira @seesawer @kdubois @sandpiper09 @jewel8888 do you have any thoughts to share with @sheker ?

@sheker has your doctor given you a diagnosis?

John

@johnbishop Thanks John for your reply.
Primary care physician took 70 days and mentioned I don't have any serious issues. But I had severe ribs pain while taking breath, yawing, burping.
So I visited Pulmonologist, in 2nd visit he ordered CT which reported nodule in the left lower lobe (2.4X2.2).Radiologist mentioned possibly nodule is post infectious and follow up CT require after 6 weeks.Pulmonologist has mentioned LUPUS is at border line (not sure LUPUS is confirmed or not). I also visited rheumatologist, rheumatologist has mentioned mild LUPUS exist.

I finished LEVOFLAXACIN anti biotech on 09/27 but still ribs pain is severe and not able to sleep.Pain while breathing gone away but ribs pain is still there. Pulmonologist asked me to go for another CT after 6 weeks to make sure nodule is gone.

Also no clue on the blood clot elevation, PE not found in the lungs, probably elsewhere blood clotted.

I am reading lot of posts in google, infection can trigger +ve ANA. In my case ANA was -ve last year November, in less than a year it turned to +ve.

Other lab tests CBP, CMP, Urine analysis, AST, ALT and Creatinine are normal.

Pain started june 4th week, still struggling.

Any advise is greatly appreciated.

@sheker

@johnbishop Thanks John for your reply.
Primary care physician took 70 days and mentioned I don't have any serious issues. But I had severe ribs pain while taking breath, yawing, burping.
So I visited Pulmonologist, in 2nd visit he ordered CT which reported nodule in the left lower lobe (2.4X2.2).Radiologist mentioned possibly nodule is post infectious and follow up CT require after 6 weeks.Pulmonologist has mentioned LUPUS is at border line (not sure LUPUS is confirmed or not). I also visited rheumatologist, rheumatologist has mentioned mild LUPUS exist.

I finished LEVOFLAXACIN anti biotech on 09/27 but still ribs pain is severe and not able to sleep.Pain while breathing gone away but ribs pain is still there. Pulmonologist asked me to go for another CT after 6 weeks to make sure nodule is gone.

Also no clue on the blood clot elevation, PE not found in the lungs, probably elsewhere blood clotted.

I am reading lot of posts in google, infection can trigger +ve ANA. In my case ANA was -ve last year November, in less than a year it turned to +ve.

Other lab tests CBP, CMP, Urine analysis, AST, ALT and Creatinine are normal.

Pain started june 4th week, still struggling.

Any advise is greatly appreciated.

Jump to this post

ANA can become positive in people with infections; viral, bacterial or fungal. However, it’s interesting that you have elevated D-Dimer. In some lupus you can have a positive caridiolipid enzyme that increases your risk of clotting. I see the lab work listed above but have they run Ig antibodies panels separate from ANA as well as run dsDNA/SSM?
I have not heard of nodules in Lupus patients. Do you have any of signs or symptoms other than the positive ANA?

The Lupus Diagnosis Criteria:

Rashes:
butterfly-shaped rash over the cheeks – referred to as malar rash
red rash with raised round or oval patches – known as discoid rash
rash on skin exposed to the sun
Mouth sores: sores in the mouth or nose lasting from a few days to more than a month
Arthritis: tenderness and swelling lasting for a few weeks in two or more joints
Lung or heart inflammation: swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis), which can cause chest pain when breathing deeply
Kidney problem: blood or protein in the urine, or tests that suggest poor kidney function
Neurologic problem: seizures, strokes, or psychosis (a mental health problem)
Abnormal blood tests such as:
low blood cell counts: anemia, low white blood cells, or low platelets
positive antinuclear antibodies (ANA) result: antibodies that can cause the body to begin attacking itself that are present in nearly all lupus patients
certain abnormal antibodies: anti-double-strand DNA (called anti-dsDNA), anti-Smith (referred to as anti-Sm), or antiphospholipid antibodies

This was pulled from the American College of Rheumatology website

@nikohl7

ANA can become positive in people with infections; viral, bacterial or fungal. However, it’s interesting that you have elevated D-Dimer. In some lupus you can have a positive caridiolipid enzyme that increases your risk of clotting. I see the lab work listed above but have they run Ig antibodies panels separate from ANA as well as run dsDNA/SSM?
I have not heard of nodules in Lupus patients. Do you have any of signs or symptoms other than the positive ANA?

Jump to this post

@nikohl7 Thanks Nikohl.
They didn't test ig antibodies. Current symptoms are ribs pain(chest and back), back muscle pain, elbow pain.
redishness in the mouth (one side) and sleep problems.

@sheker

@nikohl7 Thanks Nikohl.
They didn't test ig antibodies. Current symptoms are ribs pain(chest and back), back muscle pain, elbow pain.
redishness in the mouth (one side) and sleep problems.

Jump to this post

@nikohl7 @johnbishop
Today I got call from Rheumatologist office about C3 and C4 results, both are normal.

@sheker

@nikohl7 @johnbishop
Today I got call from Rheumatologist office about C3 and C4 results, both are normal.

Jump to this post

That’s great news! Though I’m sure it’s frustrating since it doesn’t give you any further clues as to what the problem is. Do you meet any of the lupus criteria? Usually 3-4(depending on what state you are in and insurance standards) is a pretty good indication it could be lupus. Though I have no heard of a hemothorax being caused by lupus, have you had any infectious disease testing?

@nikohl7

That’s great news! Though I’m sure it’s frustrating since it doesn’t give you any further clues as to what the problem is. Do you meet any of the lupus criteria? Usually 3-4(depending on what state you are in and insurance standards) is a pretty good indication it could be lupus. Though I have no heard of a hemothorax being caused by lupus, have you had any infectious disease testing?

Jump to this post

@nikohl7 @johnbishop
Previousely I was diagnosed with Fibro.I have few symptoms but not sure they are due to LUPUS.
Current symptoms are : Ribs pain due to pleurisy, Knees pain, redish in the mouth with mild soreness and lot of back pain (from muscles).

Here is a list of diagnostic criteria for lupus:

butterfly-shaped rash over the cheeks – referred to as malar rash
red rash with raised round or oval patches – known as discoid rash
rash on skin exposed to the sun
Mouth sores: sores in the mouth or nose lasting from a few days to more than a month
Arthritis: tenderness and swelling lasting for a few weeks in two or more joints
Lung or heart inflammation: swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis), which can cause chest pain when breathing deeply
Kidney problem: blood or protein in the urine, or tests that suggest poor kidney function
Neurologic problem: seizures, strokes, or psychosis (a mental health problem)
Abnormal blood tests such as:
low blood cell counts: anemia, low white blood cells, or low platelets
positive antinuclear antibodies (ANA) result: antibodies that can cause the body to begin attacking itself that are present in nearly all lupus patients
certain abnormal antibodies: anti-double-strand DNA (called anti-dsDNA), anti-Smith (referred to as anti-Sm), or antiphospholipid antibodies

Other symptoms associated with lupus:

Extreme fatigue (tiredness)
Headaches
Painful or swollen joints
Fever
Anemia (low numbers of red blood cells or hemoglobin, or low total blood volume)
Swelling (edema) in feet, legs, hands, and/or around eyes
Pain in chest on deep breathing (pleurisy)
Butterfly-shaped rash across cheeks and nose
Sun- or light-sensitivity (photosensitivity)
Hair loss
Abnormal blood clotting
Fingers turning white and/or blue when cold (Raynaud’s phenomenon)
Mouth or nose ulcers

What I have personally started doing is taking picture and documenting my symptoms everyday to show my doctor. Lupus is very hard to diagnose do to the varying symptoms that occur with the disease. Not every lupus patient has the same symptoms. I would consult your medical professional, take a list of symptoms and any evidence you may have. 4 out of the 11 diagnostic criteria will alert most doctors to perform more tests and have you go from there.

I hope this helps!

@nikohl7

Here is a list of diagnostic criteria for lupus:

butterfly-shaped rash over the cheeks – referred to as malar rash
red rash with raised round or oval patches – known as discoid rash
rash on skin exposed to the sun
Mouth sores: sores in the mouth or nose lasting from a few days to more than a month
Arthritis: tenderness and swelling lasting for a few weeks in two or more joints
Lung or heart inflammation: swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis), which can cause chest pain when breathing deeply
Kidney problem: blood or protein in the urine, or tests that suggest poor kidney function
Neurologic problem: seizures, strokes, or psychosis (a mental health problem)
Abnormal blood tests such as:
low blood cell counts: anemia, low white blood cells, or low platelets
positive antinuclear antibodies (ANA) result: antibodies that can cause the body to begin attacking itself that are present in nearly all lupus patients
certain abnormal antibodies: anti-double-strand DNA (called anti-dsDNA), anti-Smith (referred to as anti-Sm), or antiphospholipid antibodies

Other symptoms associated with lupus:

Extreme fatigue (tiredness)
Headaches
Painful or swollen joints
Fever
Anemia (low numbers of red blood cells or hemoglobin, or low total blood volume)
Swelling (edema) in feet, legs, hands, and/or around eyes
Pain in chest on deep breathing (pleurisy)
Butterfly-shaped rash across cheeks and nose
Sun- or light-sensitivity (photosensitivity)
Hair loss
Abnormal blood clotting
Fingers turning white and/or blue when cold (Raynaud’s phenomenon)
Mouth or nose ulcers

What I have personally started doing is taking picture and documenting my symptoms everyday to show my doctor. Lupus is very hard to diagnose do to the varying symptoms that occur with the disease. Not every lupus patient has the same symptoms. I would consult your medical professional, take a list of symptoms and any evidence you may have. 4 out of the 11 diagnostic criteria will alert most doctors to perform more tests and have you go from there.

I hope this helps!

Jump to this post

thanks @nikohl7

@nikohl7

That’s great news! Though I’m sure it’s frustrating since it doesn’t give you any further clues as to what the problem is. Do you meet any of the lupus criteria? Usually 3-4(depending on what state you are in and insurance standards) is a pretty good indication it could be lupus. Though I have no heard of a hemothorax being caused by lupus, have you had any infectious disease testing?

Jump to this post

@nikohl7
Previously when I mentioned to my physician about infections, he said he don't expect infections.
What are the lab tests require to test infectious disease?

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