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Pain Around Ribs, Granuloma On Chest And Abdomen. Have Elevated Calcium Level. Prognosis?

Posted on Mon, 11 Mar 2013

Question: I have pain on the left side around and below my ribs. This has become more constant over the past few months and rarely goes away. I also have many granuloma in this area - a growing number - which seems to have also spread further into my chest and down into my abdomen. I have had x-rays and CT scans in the past (most recently around a year ago) that stated I have calcified granuloma. Blood tests are normal except for slightly elevated calcium level on a regular basis.

Answered by Dr. Mayank Bhargava (43 minutes later)

Hi XXXXXXX,
Welcome to XXXXXXX forum.

Let me know your current blood sugar status both fasting and postprandial.
Do you have radiation of pain from back to front of chest?

With the available described symptoms, there appears to be high possibility of encroachment of calcified granulomas on nerve bundles running below ribs and also present in overlying skin.

With the elevated serum calcium, there appears to be destruction of ribs with release of calcium in blood.
In my personal opinion, you should go for excision biopsy of calcified granuloma. Calcified granuloma is a x XXXXXXX and CT scan finding and exact diagnosis could be made after biopsy.
There may be high possibility of osteoclastoma causing destruction of ribs and elevated serum calcium.

There may also be chances of diabetic neuropathy as all investigations are normal and pain is still persisting.

You should consult with XXXXXXX medicine specialist and neurologist and should go for thorough neurological check up.
You should go for complete blood count, blood sugar both fasting & postprandial, glycated hemoglobin (HbA1c), serum Vit B12 level and nerve conduction velocity studies.
You should also go for excision biopsy of granuloma with expert opinion of pathologist and surgeon.

Meanwhile, you should take medicines for neuropathic pain such as pregabalin, gabapentin, oxcarbazepine, methylcobalamin, epalrestat and multivitamin along with antioxidants.

As such there appears to be no correlation between past history of histoplasmosis and present symptoms.

Hope that helps.
Let me know your other query.
Take care,
Dr. Mayank Bhargava

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mayank Bhargava (40 minutes later)

Labs from 2/8/13: HA1c was 7.8. All other results were in normal range except for calcium slightly elevated at 10.5, which has been occurring now for a few years. CBC of 8.4. No, the pain is never in my back - continuous on left side around and below ribs. I recently had nerve conduction studies in arms and hands, which were normal. What would be causing granuloma, especially since I seem to keep having more of them? Was concerned that it could be sarcoidosis or damage caused from histoplasmosis. Any other input? (This pain in the rib area began several years ago after MVA, but has continued to get worse....and more granuloma.)
Thank you

Answered by Dr. Mayank Bhargava (6 hours later)

Hi,
Calcified granuloma indicates past illness not a current illness.
You should keep watch on growing granulomas and should go for biopsy.
Rise in calcium level with granuloma are also a matter of worry.
There may also be a chances of sarcoidosis and exact diagnosis could be made only after clinical examination.
You should take proper check up by XXXXXXX medicine specialist.
Best regards,
Dr. XXXXXXX Bhargava

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar