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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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63 years, has fatigue, back pain and cough. X-ray shows pneumonia. Low hemoglobin. Suggestions?

63 year old patient complaining of fatigue and shortness of breath, upper back pain and cough that has become productive the last 2 days. a chest Xray revealed pneumonia . rbc count is decrease, hemoglobin: decrease, wbc: normal, ESR: increased. Serum IgG is increased and both IgM and IgA are decreased. what is likely the diagnosis?
Mon, 18 Feb 2013
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General & Family Physician 's  Response
Hi and thanks for the question,
The symptoms are very compatible with pneumonia. Shortness of breath, raised ESR and chest X ray findings. Hope an appropriate antibiotherapy has been prescribed. How ever, the low Hemoglobin levels have to be investigated. Low hemoglobin levels could be caused by the infection, but if very low, other causes should be considered.
Other tests could be quite helpful in doing this assessment. Serum IgG is an indication that the infection is chronic, But IgG measurements are however very non specific and we cannot be conclusive. Knowing exactly for how long she has been coughing is too important. A chronic cough might warrant sputum exams and a tuberculin skin test to be be done to exclude pulmonary tuberculosis.
The back pain might require a spinal x ray, ESR, alkaline phosphatse levels, Complete blood count, serum electrolytes to exclude any bone malignancy.
I suggest visiting an internist with these ideas in mind could help min a proper reevaluation and management of your patient.
Thanks and hope this helps,
Luchuo, MD.
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Internal Medicine Specialist Dr. Sudhir's  Response

In view of details there two possible diagnosis in your case.First is marrow suppression due to some underlying cause leading to low RBC and WBC. This low cell counts make person prone for infection and so second possible diagnosis is opportunist infection in lungs leading to pneumonia.

I would recommend a need more detailed evaluation in your case.


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