Q: I am 65, Scandinavian, female, and in good health. Five years ago blood work when I had painful joints showed I have Sjogrens, which has not been a problem. A year ago I got pneumonia. I had severe pain down my left side. I still have some pain there and also always have pain in my chest in various areas. I have random breathlessness. CT scans show some infiltrates and cloudiness in my lungs. I had a bronchoscopy. I do not have cancer, hot tub lung, a mold, or TB. My heart is fine. My breathing tests are fine. My internist and pulmonologist do not know why I have the discomfort.
Do you know what could be causing the pains in my chest and the breathlessness? Could this be from Sjogrens? I have been having some discharge from my eyes for several months. I read your column and you wrote about sarcoidosis. I wonder if that is my problem? My only other health issue is varicose veins for which I receive treatment.
Thank you for writing your column which I find interesting and informative.
A: Thank you for the compliment. Now let’s see if we can come up with some answers for the plethora of conditions you suffer from.
Approximately 4 million Americans suffer from Sjogren’s syndrome which is an autoimmune disorder, meaning a person’s immune system incorrectly attacks its own body cells and tissues. Initially Sjogren’s attacks the moisture secreting glands of the eyes and mouth, causing them to become dry; however, the disorder can also damage the kidneys, liver, lungs, thyroid, skin and nerves. Some individuals may experience a persistent dry cough, chronic fatigue, dry skin, swollen salivary glands, joint pain, and a skin rash. Symptoms may worsen, remain steady, or on rare occasion, go into remission. Some people are minimally affected, while others experience debilitating issues that dramatically affect their quality of life.
An infiltrate implies the lung airspaces fill with fluid (pulmonary edema), pus, protein or cancer cells identified as a soft tissue density on X-ray. This may occur from pneumonia, tuberculosis, silicosis, asbestosis, and more. Depending on the severity of the condition, infiltrates can involve a small area of the lung that will cause minor symptoms, or may fill an entire region of the lung, causing a very serious disorder. A condition known as actinomycosis can cause fever, cough and mucus production as pus collects in the pleural spaces. Pneumonia, another possibility for an infiltrate is bacterial or viral in nature. Symptoms may include headache, fever, joint and muscle pain, followed by cough, chest pain and shortness of breath. According to the University of Maryland Medical Center, scattered infiltrates will reveal a massive influx of white blood cells that attack the bacteria or virus and produce pus. People with this infection may cough up green or yellow mucus.
The sarcoidosis I wrote about recently is an abnormal collection of chronic inflammatory cells that can form as nodules in several organs. Symptoms may be vague and may include fatigue, weight loss, arthritis, dry eyes, knee swelling, a dry cough, rash, and a great deal more. The exact cause for this condition is unknown; however, it is believed caused by a change in the immune system that results from exposure to occupational, infectious or environmental agents. I wouldn’t put my money on you having sarcoidosis.
The causes for chest pain are many and they aren’t all cardiac related. In fact, as much as one fourth of our country’s population experiences chest pain unrelated to the heart. The first I’ll discuss is pleurisy, inflammation or irritation of the lining of the lungs and chest. A sharp pain on inhaling and exhaling may be present. The most common cause for this is a bacterial or viral infection or a pulmonary embolism. Less common causes include lupus, rheumatoid arthritis and cancer. Then there is pulmonary hypertension – unusually high blood pressure in the lung arteries that forces the right side of the heart work too hard. Gallbladder problems following the ingestion of a fatty meal may cause fullness or pain in the right lower chest or in the right upper side of the abdomen. Esophageal contraction disorders can also cause chest pain. And, I have left out asthma. GERD or esophageal spasm that may be the cause for your dyspnea, peptic ulcers, hiatal hernia, and other conditions I don’t feel are to blame.
While I recommend this often, I feel you need a second opinion with a pulmonologist and perhaps testing such as a repeat chest X-ray, echocardiogram, an echo or exercise stress test, and possible MRI. Something is not showing on the testing you have undergone but something is amiss. Be sure to bring the reports and films for testing already performed. Good luck.