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Have severe chest pain. Suffer from pleurisy. Have itching on tongue and palms. What should I do?

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Posted on Wed, 5 Jun 2013
Question: I have had severe chest pain on the left side when breathing for months.I have suffered from pleurisy many times and it has never felt this bad. It feels like my left lung and breathing became difficult so I was put on steroids that are not helping much. I can breathe better but the pain is just as bad. I have had scapular pain (left) for a year. I have major itching every night for two weeks even my tongue and palms of my hands. I take Benedryl to get through it. What tests should I ask for? I had a chest X-ray and will review it Monday.
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Answered by Dr. Satyadeo Choubey (3 hours later)
Hi XXXXXX,
Thanks for your query,
Pleuritic chest pain usually is sharp severe with catches on maneuvers like deep inhalation, coughing, sneezing etc. Usually it signifies infection.
For rheumatic pleuritis, patients are usually male, it precedes the arthritis, commonly found in sero-positive disease and it readily responds to steroid. So your doctor are right in questioning the diagnosis.
At this juncture, if your chest x-rays shows evidence of fluid, get it aspirated under ultrasound guidance and subject it to routine microscopy, biochemical examination, ADA, gram's stain, AFB stain, culture, amylase. If your x-ray do not show any evidence of fluid you can go direct for ultrasound chest or else CT scan chest.
In the meantime you can take some analgesiscs like paracetamol or ibuprofen along with antibiotics like cefixime and azithromycin.
Since the pain is on left side, it will be better to go for electrocardiography (ECG), just to rule out anginal pain, though seems less likely.

Thanks and Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Satyadeo Choubey (8 minutes later)
I appreciate the input. I also have bed soaking night sweats and significant breast pain in my left breast. That has been going on for six months or more intermittently. My family has a long history of cancer, in fact my daughter has it. I watched her diagnosis be put off for almost a year, and I have fear that Something is being missed. Should I be that concerned? Every generation of my family for as far as we know on both sides has had cancer.
doctor
Answered by Dr. Satyadeo Choubey (13 minutes later)
Thanks for follow up,
With a family history of breast cancer, it becomes mandatory to go for self breast examination. And if any sort of lump in breast or axilla is detected, doctor must be consulted. To rule out, at this time, you may go for mammography of your both breast, which is easily available with the radiologists.
Bed soaking night sweats can be due to any chronic disease, most commonly tuberculosis, which can be diagnosed on x-ray and pleural fluid examination as stated before.
If fluid is detected on x-ray and aspirated, get it sent for malignant cytology also.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Satyadeo Choubey (23 minutes later)
Thank-you for your input.
doctor
Answered by Dr. Satyadeo Choubey (2 minutes later)
Thanks and good luck.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Satyadeo Choubey

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Practicing since :2006

Answered : 554 Questions

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Have severe chest pain. Suffer from pleurisy. Have itching on tongue and palms. What should I do?

Hi XXXXXX,
Thanks for your query,
Pleuritic chest pain usually is sharp severe with catches on maneuvers like deep inhalation, coughing, sneezing etc. Usually it signifies infection.
For rheumatic pleuritis, patients are usually male, it precedes the arthritis, commonly found in sero-positive disease and it readily responds to steroid. So your doctor are right in questioning the diagnosis.
At this juncture, if your chest x-rays shows evidence of fluid, get it aspirated under ultrasound guidance and subject it to routine microscopy, biochemical examination, ADA, gram's stain, AFB stain, culture, amylase. If your x-ray do not show any evidence of fluid you can go direct for ultrasound chest or else CT scan chest.
In the meantime you can take some analgesiscs like paracetamol or ibuprofen along with antibiotics like cefixime and azithromycin.
Since the pain is on left side, it will be better to go for electrocardiography (ECG), just to rule out anginal pain, though seems less likely.

Thanks and Best wishes