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Wednesday, April 23, 2014
Sarcoidosis - Confused About My Diagnosis
I`m a 45 year old female and in good health - I have thyroid disease, minears disease and am hypoglycemic. All are controlled by medication and diet. About 3 weeks ago I woke up with a tight, uncomfortable feeling in my right ribcage area (below the breast) like I was going to cramp up. I got up and got ready for work thinking maybe I slept wrong and it would work itself out. However, about 30-45 min. later I began having bad spasm like pains in my right ribcage area (under my breast) and in my mid abdominal area (between my rib cage). I stayed home that day and used heat and flexoril thinking I would feel much better the next day, but the next day the pain was worse and was in my back as well. Upon direction from my family doctor I went to Urgent Care for a chest xray and EKG to rule out any heart problems. Both tests were normal and I was told it was Costocondritis and was prescribed 800 mg of ibuprofen 3x daily and advised to use ice instead of heat. Even thought I was getting no relief and the pain in my back was increasing, I waited for 3 days to give the medicine a chance to work. When no relief came, I called to see if they could give me something stronger for the pain. They sent me to the emergency room because they were very concerned about the pain in my back getting worse. I went to the emergency room, they did the same tests (chest xray and EKG), they also did an ultrasound of my liver, kidney, galbladder, and any other organs in that general area, as well as a blood test to check for a blood clot, but all tests were negative. I followed up with my family doctor the next day who sent me for a CT scan of my chest area. I was told that the test showed Sarcoidosis of the lymp nodes in my lungs near the trachea area; however, the blood test to back up that diagnosis were negative. No cancer or tumors were found. She has now directed me to see a pulmonary doctor. My problem is that my chest is feeling better, but my mid back still hurts so bad I`m almost in tears as I write to you (having a bra on or sitting upright in a chair are so very painful). I can`t get anyone to address my back pain and the literature they gave me at the doctor`s office regarding the symptoms of Sarcoidosis say absolutely nothing about back pain. I`ve been given Vicodin and a pack of Methylpred for the pain. MAIN QUESTION: Can Sarcoidosis in the lymp nodes in my lungs really be causing me this much pain in my back? Because the CT scan is so intense, does it happen to show clear through to the back area as well?
The severe back pain you describe would be unusual for sarcoidosis. However, the chest pain definitely could relate to sarcoidosis, and it seems from your description that this symptom did improve with corticosteroids and ibuprofen. I agree with seeing the pulmonologist to determine if you do indeed have sarcoidosis and whether you need specific treatment for this. However, I would not assume at this point that the severe back pain relates to sarcoidosis.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University