Question: Hi I have been suffering from sinusitis for the last 3 months. Initially I had a cold and then had fevers and pain. I was put on Augmentin with no success. Next a regime of doxycycline which I think greatly assisted as I started feeling a lot better however still have a blocked feeling in my nose and when I am able to clear a yellow/brown discharge. I sometimes get epistaxis and so have been put on prednisone at 25mg/day for the last month which I find greatly helps reduce the pain and very little nose bleeds now. The GP ordered a chest CT and found 4 small lung nodules on the left upper lobe in size from 4- to 10mm spherical and non-calcified. The gp/ and went specialist that I have just been referred too are now not really sure what to make of it as I still have the sinusitis (albeit nowhere near as bad without fevers or significant pain), I have the lung nodules (which may or may not have already been there), I have elevated CRP (about 60) and slightly raised neutrophils but all my other liver and kidney and immunoglobulins are fine. Autoimmune tests including ANA, ENA, XXXXXXX tested twice and all negative. Where do I go from here, what other tests should I perhaps look at and what other diseases could it be. Initially they suspected Wegner's but are no longer certain, but believe there is obviously some inflammation continuing. Could it be allergy, or fungal? Although with no other symptoms?? Running out of ideas on how to proceed? Looking forward to expert feedback.

Yes I have gone to an ENT and he performed a endoscopic examination although he noted difficulty at the time in seeing much due to a fair amount of 'crusty' gunk as he put it. He also wasn't convinced it was a simple case of chronic sinusitis as I have some conductive hearing loss (only in one ear) but this all began when I went flying initially with the sinus infection (I am a pilot). Some of it has come back but not completely. I haven't had any issues with other ear. The other thing is I had inflamed gums at the time but again this could be coincidental as I failed to brush my teeth at the time for a number of days due to the pain. Once I had a clean done the gingivitis disappeared so again I am not convinced the ear and gums are related to the sinus disease. The ENT was intact that Dr that ? Wegener's due to his evaluation of a systemic disease and ordered the blood tests and chest CT. With allergies wouldn't my IgE levels be elevated? They appear to be normal at the moment. I have suspected allergy rhino sinusitis as I sneeze a lot (several times a day) too. I have suggested allergy testing to him however he discounts it. Im not entirely sure why. He also discounts that there is still an infection there (although he may be correct as I would probably be a lot sicker than I am (generally feel pretty well apart from annoying sinuses) or a fungal infection (again I would presume unlikely)?

If I am on prednisone at the moment will the taking of antihistamines/antiallergy drugs be contraindicated?

Any further advice or information would be greatly appreciated, in particular your assessment of possible Wegner's?

Thanks

Yes I think about my situation every day. I just want to get to the bottom of it. I was going to have a biopsy but then decided not too as he said in most cases it is nonspecific anyway and so really if to rule out a lung biopsy would be the choice. He was hinting at reducing the prednisone and doing a repeat ct and if nodules still there do a biopsy of long but yeah not keen on this with the risks. Culture and sensitivity only done on my nose not sinuses. Wouldnt he need to carry out a facilitated endoscopy for this? Culture of my nose showed normal flora but this was after doxy treatment

Largest nodule is 10mm located in left upper lobe. Ok I will ask ENT specialist to carry out although he saud good news is no surgery needed??