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Nasal congestion. On allegra, nasonex and antibiotics. Chest x-ray showing granulomas. Taking prednisone. Any suggestions?

I have had bronchial and now nasal congestion on and off since the end of December. I was put on antibiotics which didn t do much. I saw an allergist who performed the skin test and no allergies showed up. It is not asthma. I was put on Allegra and Nasonex , which didn t help much. I had a chest xray which only showed some granulomas but nothing significant. I was most recently put on prednisone and a stronger nasal spray to reduce inflammation and dry up the nasal passages. However, I am done with the prednisone and today I am still congested. My next step is to get a sinus cat scan. WHAT ON EARTH IS THIS??? I often cannot fully speak because there is so much snot and phlegm in my nasal area. It s gross!!
Asked On : Fri, 1 Jun 2012
Answers:  1 Views:  85
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Allergist and Immunologist 's  Response
Granulomas in the upper airways (nose) or lower airways (lung) needs proper evaluation.
The differential diagnoses:
1. ANCA positive vasculitides - that require exclusion with ANCA, MPO PR3 blood tests, urea creatinine. If PR3 is positive, Wegener's granulomatosis is a distinct possibility.
2. Sarcoidosis - ANCA is negative in this condition where granulomas form, and ACE levels (blood test) can be high in some patients.

Steroids with immunosuppressive drugs are the treatment options.

I hope that was useful.
Best Wishes.
Answered: Sun, 9 Jun 2013
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