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Is Positive ACE Test An Indictaor Ofsarcoidosis?
Question: Hello Dr. Arnab!
Hope you still remember that I contacted you a week back with the case of my mother's Lung disease. After going through the CT Scan and 2D-ECHO report you had said that she has Pulmonary Fibrosis as well as Pulmonary Edema.
The doctor is treating her with MUCINAC, LASILACTONE-20 and ASSURANS and had asked us to get some medical tests done before we go to him for review after 10 days.
The LFT and KFT tests are OK.
ESR 35 [0 - 30] - High
ACE 78 [8 - 65] - High
ANA 4 [<20] - Normal
HB 10 [ 11.50 - 15] - Low
As I told you earlier too that my mother is also having diarreha and it seems to have increased after starting the medication for ILD 10 days back. Is it due to the NAC medicine (mucinac) (somewhere it was written that diarrhea is a side effect of this medicine). This is weakening her and she feels very uncomfortable going to the washroom again and again. She goes 2-3 times in the morning after she takes this medicine. Then same thing repeats in the evening after dinner when she again takes this medicine. As she doesnt consume this medicine in afternoon so the problem does not occur in the afternoon.
Now, in the light of above tests ACE and ANA, can you please answer my new questions:
1. If the Fibrosis she has is Idiopathic or not? What I have researched on internet is that IPF is unstoppable (though may be slowed down) and has no known cause.
2. Is the positive ACE test an indictaor of Sarcoidosis? If so, then can this be called as PF instead of IPF and can the treatment for Sarcoidosis stop the fibrosis from increasing further or will it be unstoppable too?
3. Can this problem of diarrhea be treated separately or is it going to remain like this only - be it due to medications or due to ILD?
4. My mother seems to feel some impact on her eyes. Is it also due to ILD and will there be separate treatment for this to be done by Eye specialist?
5. I came across someone in my office whose relative is suffering from PF (may be IPF) for since 2004. He is on and off taking allopathic medication (steroids etc) but he is also taking AloeVera Juice and Apple Cider Vinegar for last few years and feels his breathing has improved. But when I searched for this kind of treatment on internet I found Aloe Vera acts as laxative and I fear this may further increase diarrhea in my mother. Also Apple Cider Vingear itself acts as a diuretic and may interfere with diuretic my mother is already taking. Can you suggest if it is safe to consume these two things and if my doubts are just an over reaction?
Sorry to bug you again and again doctor, but I hope you will be kind again to help me out. Actually, to be honest, it is rare to find doctors who become patient while listening to queries and then answer them. And I found you too good with this aspect.
Thanks
XXXX
Hope you still remember that I contacted you a week back with the case of my mother's Lung disease. After going through the CT Scan and 2D-ECHO report you had said that she has Pulmonary Fibrosis as well as Pulmonary Edema.
The doctor is treating her with MUCINAC, LASILACTONE-20 and ASSURANS and had asked us to get some medical tests done before we go to him for review after 10 days.
The LFT and KFT tests are OK.
ESR 35 [0 - 30] - High
ACE 78 [8 - 65] - High
ANA 4 [<20] - Normal
HB 10 [ 11.50 - 15] - Low
As I told you earlier too that my mother is also having diarreha and it seems to have increased after starting the medication for ILD 10 days back. Is it due to the NAC medicine (mucinac) (somewhere it was written that diarrhea is a side effect of this medicine). This is weakening her and she feels very uncomfortable going to the washroom again and again. She goes 2-3 times in the morning after she takes this medicine. Then same thing repeats in the evening after dinner when she again takes this medicine. As she doesnt consume this medicine in afternoon so the problem does not occur in the afternoon.
Now, in the light of above tests ACE and ANA, can you please answer my new questions:
1. If the Fibrosis she has is Idiopathic or not? What I have researched on internet is that IPF is unstoppable (though may be slowed down) and has no known cause.
2. Is the positive ACE test an indictaor of Sarcoidosis? If so, then can this be called as PF instead of IPF and can the treatment for Sarcoidosis stop the fibrosis from increasing further or will it be unstoppable too?
3. Can this problem of diarrhea be treated separately or is it going to remain like this only - be it due to medications or due to ILD?
4. My mother seems to feel some impact on her eyes. Is it also due to ILD and will there be separate treatment for this to be done by Eye specialist?
5. I came across someone in my office whose relative is suffering from PF (may be IPF) for since 2004. He is on and off taking allopathic medication (steroids etc) but he is also taking AloeVera Juice and Apple Cider Vinegar for last few years and feels his breathing has improved. But when I searched for this kind of treatment on internet I found Aloe Vera acts as laxative and I fear this may further increase diarrhea in my mother. Also Apple Cider Vingear itself acts as a diuretic and may interfere with diuretic my mother is already taking. Can you suggest if it is safe to consume these two things and if my doubts are just an over reaction?
Sorry to bug you again and again doctor, but I hope you will be kind again to help me out. Actually, to be honest, it is rare to find doctors who become patient while listening to queries and then answer them. And I found you too good with this aspect.
Thanks
XXXX
Brief Answer:
Please go through the text
Detailed Answer:
Hello
Thanks for your query.
1. The diagnosis of idiopathic fibrosis can only be made only after the exclusion of known causes like connective tissue disorders, occupational disorders and drugs. For this your doc needs to take detailed history regarding these aspects and along with ANA ( which is found to be negative in this case ) your mother has to go for serum anti-dsDNA, anti-CCP and anti-topoisomerase antibody testing. You are right the IPF is a disease which has a worse prognosis may undergo a rapid downhill course also.
2. Serum ACE may be increased in sarcoidosis but it is neither specific nor diagnostic because it may be elevated in other tests also and it is also just elevated. So you have to go other tests also to diagnose sarcoidosis conclusively. For IPF to be diagnosed as I earlier said your mom should undergo the tests as I previously mentioned.
3. In all probability the diarrohea is due to mucinac and if it is intractable that drug should have to be withdrawn and other drugs are to be tried.
4. Eye symptoms are more common in sarcoidosis as well as in Zogren syndrome. I think you should consult an Eye specialist to have a diagnosis on that lesion so that the work for the pulmonologist getting easier.
5. We being the pulmonologist can never recommend your mother to consume those two things because no where in the treatment options those two things are mentioned either in the standard text book or recent research papers. I think you should continue the medications as prescribed by your doctors and if diarrhea occurs then it can be replaced by perfenidone but that is to be started only after consulting your doctor.
You can ask me if you have any further queries without hesitation any time.
Thank you
Regards,
Dr Arnab Maji
Consultant Pulmonologist
Please go through the text
Detailed Answer:
Hello
Thanks for your query.
1. The diagnosis of idiopathic fibrosis can only be made only after the exclusion of known causes like connective tissue disorders, occupational disorders and drugs. For this your doc needs to take detailed history regarding these aspects and along with ANA ( which is found to be negative in this case ) your mother has to go for serum anti-dsDNA, anti-CCP and anti-topoisomerase antibody testing. You are right the IPF is a disease which has a worse prognosis may undergo a rapid downhill course also.
2. Serum ACE may be increased in sarcoidosis but it is neither specific nor diagnostic because it may be elevated in other tests also and it is also just elevated. So you have to go other tests also to diagnose sarcoidosis conclusively. For IPF to be diagnosed as I earlier said your mom should undergo the tests as I previously mentioned.
3. In all probability the diarrohea is due to mucinac and if it is intractable that drug should have to be withdrawn and other drugs are to be tried.
4. Eye symptoms are more common in sarcoidosis as well as in Zogren syndrome. I think you should consult an Eye specialist to have a diagnosis on that lesion so that the work for the pulmonologist getting easier.
5. We being the pulmonologist can never recommend your mother to consume those two things because no where in the treatment options those two things are mentioned either in the standard text book or recent research papers. I think you should continue the medications as prescribed by your doctors and if diarrhea occurs then it can be replaced by perfenidone but that is to be started only after consulting your doctor.
You can ask me if you have any further queries without hesitation any time.
Thank you
Regards,
Dr Arnab Maji
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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