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Tuesday, March 11, 2014
Could it be IPF?
I am a 25 yr old female, non smoker. For the past 2 months I have had shortness of breath, I can barely do anything. My nails are a purplish color and I have a dry cough once in awhile. My pulse ox and chest ct was normal as well as a cardiac MRI. I really feel like I am having trouble breathing and the nails are really scaring me! I saw a pulmonologist who was not too concerned about the nails. Looking online, I am terrified of pulmonary fibrosis. Could my symptoms be that? Any advice would be a help... I am tired of rushing to the er and just want to be a normal 25yr old
Purple nails can be due to cyanosis (low blood oxygen), Raynaud's phenomenon (constriction of the blood vessels in the fingers and hands), and methemoglobinemia (abnormalities of the hemoglobin in the red blood cells due to exposure to certain medications or toxins). An arterial blood gas drawn when the nails are purple will tell you if the oxygen level is low and whether there is methemoglobinemia. The pulse oximetry will be low if the blood oxygen level is low and the pulse oximetry typically reads about 85% if there is methemoglobinemia. Raynaud's phenomenon is typically triggered by cold air exposure.
A normal chest CT scan goes a long way to excluding pulmonary fibrosis and moreover, most causes of pulmonary fibrosis are extraordinarily rare in otherwise healthy 25-year-old persons. If there is still a question about pulmonary fibrosis or other types of interstitial lung disease, pulmonary function studies may be helpful. Sometimes we have to do an exercise test or at least measure the pulse oximetry during exertion to determine if the oxygen level can be falling to account for the purple fingernails.
James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University