Nasal congestion. On allegra, nasonex and antibiotics. Chest x-ray showing granulomas. Taking prednisone. Any suggestions?
Patient: I have had bronchial and now nasal congestion on and off since the end of December. I was put on antibiotics which didn t do much. I saw an allergist who performed the skin test and no allergies showed up. It is not asthma. I was put on Allegra and Nasonex , which didn t help much. I had a chest xray which only showed some granulomas but nothing significant. I was most recently put on prednisone and a stronger nasal spray to reduce inflammation and dry up the nasal passages. However, I am done with the prednisone and today I am still congested. My next step is to get a sinus cat scan. WHAT ON EARTH IS THIS??? I often cannot fully speak because there is so much snot and phlegm in my nasal area. It s gross!! Doctor: Hello,Granulomas in the upper airways (nose) or lower airways (lung) needs proper evaluation.The differential diagnoses:1. ANCA positive vasculitides - that require exclusion with ANCA, MPO PR3 blood tests, urea creatinine. If PR3 is positive, Wegener's granulomatosis is a distinct possibility.2. Sarcoidosis - ANCA is negative in this condition where granulomas form, and ACE levels (blood test) can be high in some patients. Steroids with immunosuppressive drugs are the treatment options.I hope that was useful.Best Wishes.