pain in back and shoulder

[kellylm]

hi,
i have pain in my right lower lobe of my lung and my right shoulder every time i breathe. i do have a medical history and didnt know if this was related. my gp thinks that i have sle. she says i have every symptom. my ANA has been pos for 4-5 years except this month when it came back neg for the first time. after they drew blood i felt great for 2 days. no pain no nothing, felt normal for a change cause its been about 7 years. my pain started earlier this year when i developed pleursey. the stabbing pain went away as well as the spasms after weeks of taking nsaids. i had a different kind of dull pain that was constant and has stayed. i still wheeze and cough (now productive but no blood). i have been a smoker for about 8 years. because my symptoms got worse i went to the er and they took an xray and ct scan. ct scan showed that my bronical airways were constricted and they found something in my lower lobe of my right lung. gave me 2 breathing treatments and i went to my pulmonologist. nobody could tell me what it was, they said everything from cancer to emphazema to asthma. i got 2 inhalers and pain meds and nothing works at all. now everytime i breathe my right shoulder hurts too.can anybody tell me what they think about this.

thank you

[John Kenyon, CNA]

Hello -

Everything you describe, plus your history, suggest asthma or chronic bronchial inflammation (possibly due to SLE), with some residual right lower lobe congestion that probably needs to be broken up by regular, therapeutic breathing treatments. Since your cough is productive but not bloody, it may be you've developed an autoimmune variant of pneumonia that's become chronic. This can even be a mild form of bronchiolitis obliterans organizing pneumonia (BOOP), which is often missed in tests because of its unique nature (no infection, yet it mimics mild to severe pneumonia without most of the systemic signs such as fever, that would normally be seen). This and othere similar sorts of chronic interstitial lung disorders, are often treated successfully with steroids.

It would seem a consult with a pulmonologist may be in order. The pleuritic pain can accompany almost any sort of lower respiratory infection or psuedoinfection, and may linger for quite a while even after the acute problem has resolved. It would help to have even a broad diagnosis ("could be A, B or C) rather than just having a lot of possible causes tossed out and no attempt to narrow it down and get it resolved.

Hopefully this is helpful to you. A more thorough workup is required to get to the bottom of the problem. One way would be to test for SLE and rule it in or out. Another would be to have a bronchoscopy done to see if that RLLL congestion is actually BOOP, which sometimes must be biopsied (or at least a specimen obtained) in order to identify it, since it creates a unique sort of almost cellulose-like material instead of ordinary mucus.

Best of luck to you with this, and please do follow up as needed.