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Hetrosexual male. Over weight. Having joint pains. Suggested connective tissue disorder. Had sex with a hooker. Chances of HIV infection?

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Rheumatologist
Practicing since : 1996
Answered : 11 Questions
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Hello I am a 41yr old Hetrosexual Cuacasion male from Brisbane Australia - I am overweight at 116KG however I still can play sport 4 times a week covering more than 22Klm per week.

I have spent the last 8yrs (yes 8) trying to troubleshoot my worsening medical problem - it started with joint pains which was thought to be gout due to high uric acid, however after several MRI's it was found that damage was being done that was suggestive of connective tissue disorder, this progressed over a few years with steroid treatment being the only thing to work.

Before traveling OS to Thailand and Germany in 2006 I had special immunisation for some german measles thing that was happening at the time, While in ThaiIand I had sex with a hooker and after oral sex had a very bad chest infection - the condom also broke and I was told the hooker may have HIV and was given antirtrovirals for 2 weeks - Upon returning home I started noticing that when I had sat still for a long period of time I had air hunger and a feeling of not enough O2, they investigated and found my sats were at 96% - this lasted for about a year and I was prescribed CPAP 10PSI - a sleep study was conducted and my O2 sats went to around 85 at times at night -

The air hunger got worse and worse and worse - but only when relaxing and sitting still - I play soccer 3 - 4 times a week and am never really short of breath so it was odd that I had low O2 and I had ever really been a heavy smoker.

They did a CT and found patchy infiltrates and fluid in lower lobes but nothing major and there was no sign of infecion in the blood stream -

I started getting pain in the chest and upper abdomen so they did a PH study and found that I had large acid coming up at night and pooling in the chest so they performed a fundiplication surgery which I dont think went well.

Chest Pain continued and sats were dropping further so I had numerous tests - one of which was a shunt study - showing a 11% shunt however a bubble study showed no shunt in the heart and I have had a total now of over 8 CT Scans - I have had

1/ Stress Echo - Normal with just a bit of regurgitation
2/ Excericise stress test x 3 - all fine
3/ Mips and Meps fine
4/ Spirometory - all fine
5/ Tilt Test
6/ Bronch x 3 squamous metaplasia - often multiple lung infections and blood around metaplasia but no malignancy
7/ Asthama Challenge test
8/ Echo Cardiogram
9/ CT Spiral Angio - slightly atipical as the contrast did not spread properly
10/ D/Dimer Test
11/ Gallium Scan
12/ Methotrexate Trial
13/ Thoracic video exam laprascopiclly of the Pluera
14/ Gastrocopy - inflamed stomach wall
15/ Endoscopy - normal

I am currently ONCE AGAIN in hospital with chest infection and O2 sats of 89 on room air - I again have Heomoptisis and as always I have an rather annoying sound (crakle or rale) after exhale - this happens all the time nd is getting louder.

I am constantly feeling unwell and have to keep taking time of work, I have lost 2 jobs and to partners and I want to start a family (actually I wanted to 8 years ago)

Other clinical details of note;

Bloods:
High Uric Acid - even on allopurinol 30
High Chol - even on Lipitor 20
Biliruben - abnormal
AFT - Abnormal
AST - Abnormal

Other Medical:
Psoriasis - Head penis, bottom, behind ears and chest
Multiple chest lipomas
Liver Changes
Fundoplication does not seem good - seems as if water is trapping in the eosophogas and it moves as I breathe - possibly going into lungs

It has been suggested that there is possibly a Heptopulmanoary shunt - and I plan to get a fibrscan and MRI doen of the liver - my current respiratory physician is suggesting a Picc Line and extending antibiotics.

Basiclly, when I breathe I can feel the stuff in the very bottom of my lungs, but I cant get it out, I constantly have a post nasal drip and it goes down but wont come back up - on light exhale my lungs will make crazy sounds - but not at full exhale - they are worse when lying on my side, making it hard to sleep - my tomach makes a weird noise like pouring a thin line of water into a steel coffee cup - fluids moving from one chamber to another, I have blood around the anus, but I am told this may be piles

Mate I have had enough of this affecting my life, and I am scared of the PICC line as I am not entirely sure I dont have problem somewhere in my veins from the high cholestorol.

Can you suggest anyhting

Thanks in advance - I do have recorded audio of the stomach and lung noises

Please Help
Posted Tue, 27 Aug 2013 in Lupus
 
 
Answered by Dr. Parshant Aggarwal 8 days later
Hi

Thanks for your query.

You have mentioned the details of your problem quite well.

After the history of condom breakdown, I would like to know your HIV status. Since your liver function tests are abnormal, I think hepatitis virus serology is required. Also in view of shortness of breath, bleeding from stools, you need to be evaluated for myopathy.

I would suggest a couple of investigations if they haven't been done already- HIV, hepatitis B & C serology, Haemoglobin (initial & current), WBC count (initial & current), ESR/ CRP, urinalysis. Additionally XXXXXXX XXXXXXX serum ferritin, serum CPK, LDH needs to be done.

Kindly inform these reports at the earliest.
Above answer was peer-reviewed by
 
Follow-up: Hetrosexual male. Over weight. Having joint pains. Suggested connective tissue disorder. Had sex with a hooker. Chances of HIV infection? 7 hours later
Hello Doc,


There has been a bot more found out since I asked this qtn, I hae since had tests for Hep HIV and CMV - they found I am CMV IgG positive but HIV negative

Total IgG 5.3
IgG1 3.2
IgG2 1.6
IgG3 0.09
IgG4 0.15

My spleen is enlarged as well

Pretty sure they have tested fr both Hep types but will check today WBC sems to be fairly normal usually, they have found nuetraphils before. ESR is usually normal CRP flares up from time to time, but only when other areas other than my chest are involved. Hvent done Urinalysis for a long time so will ask about that today ... XXXXXXX and XXXXXXX have been tested as nrmal many times but what is serum ferritin, is that part of the normal XXXXXXX XXXXXXX testing?

Whats is CPK a test for - dont think I have had that one nor LDH

Whats in your thughts, i thought possibly lupus, but dc thinks it is some kind of IDS but could the IgG results be low becasue of prednisone
 
 
Answered by Dr. Parshant Aggarwal 19 hours later
Hi, thanks for your prompt response.

Serum ferritin test is not a part of XXXXXXX or XXXXXXX testing. It is a marker of inflammation as well as a marker of body iron stores. If there is a disease causing inflammation (swelling) in your lungs then ferritin levels could be elevated. In certain diseases there can take place bleeding inside the XXXXXXX organs (for eg lungs which can lead to patchy infiltrates) in which case serum ferritin levels could be low.

Another cause for shortness of breath could be a disorder of muscles or Myopathy. Lipitor can also lead to myopathy. Serum CPK(Creatine phosphokinase) and LDH(lactate dehydrogenase) are tests for muscle disorder.

Majority of cases of lupus are XXXXXXX positive. Since your XXXXXXX is negative I wouldn't consider lupus.
CMV infection explains majority of your symptoms and should be considered as the first diagnostic possibility.

Regards and best wishes
Dr Parshant Aggarwal
Above answer was peer-reviewed by
 
Follow-up: Hetrosexual male. Over weight. Having joint pains. Suggested connective tissue disorder. Had sex with a hooker. Chances of HIV infection? 7 hours later
they are saying that I have CVID - I tend to agree - however i do have inflamed lungs etc al th time and joint pains - so I am wondering if there are any rhuematlogical diseases that can affect IgG levels?
 
 
Answered by Dr. Parshant Aggarwal 26 hours later
Hi
CVID is a primary immunodeficiency disorder (it results from faulty development of the immune system since childhood) while rheumatological disorders are acquired disorders (which you acquire or develop in response to interaction with various enviromental factors in appropriate genetic milieu). CVID tends to present early in life. At times it can present in 2nd or 3rd decade of life. Onset of symptoms at 41 years of age would be odd.
I would suggest that measurement of other Immunoglobulin subclasses IgA, IgM, IgE is also required especially IgA.
Low Ig levels does not necessarily mean a functional immune abnormality. Hence functional defect needs to be assesed- this can be done by looking at response to vaccination (for eg pneumococcal and tetanus).

Rheumatological cause to lead to IgG deficiency would be unlikely. However there are certain causes of acquired IgG deficiency that need to considered in your case before making a diagnosis of CVID- durgs (esp anticonvulsants, Sulfasalazine, steroids, antimalarials, gold-can be present in various alternative drugs), gastrointestinal disorders (protein losing enteropathy- measure serum albumin, stool alpha 1 antitrypsin), nephrotic syndrome (see urine albumin), malignancies (clinical evaluation, blood counts, if required bone marrow evaluation, serum electrophoresis).

Regards and best wishes
Dr Parshant Aggarwal
Above answer was peer-reviewed by
 
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