Hematology/MCTD?????

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Question
Until a year ago, my blood work had always been fine except for elevated cholesterol and sed rate.  I have had chronic post nasal drip over 40 years despite having negative scratch allergy tests over the years. I also have early onset osteo arthritis which has resulted in severe bone spur formation in my spine and knees. I had ruptured my posterior tibial tendon and have had reflux for 6 years. Since November 2012, I had frequent sinus inflammation, infections, bronchitis, brain fog, flushing, itching, on and off rashes, low grade fevers, dizziness, fatigue etc etc.  I had extensive workups by an ENT, rheumatologist, Infectious Disease Doctor and Immunologist.  

May 2013, I had an pericardial effusion which necessitated having a liter of blood drained.  The effusion reformed and I went into tapenade. I had a pericardial window.  The biopsy showed evidence of both acute and chronic inflammation.  The immunologist I was referred to about 8 months ago.

Two months ago, a dermatologist did a patch test when she saw how I was scratching up my back.  It was positive for reactions to   Lidocaine, ropylene Glycol,Carba Mix,Balsam of Peru, Thiuram Mix
Lyral, cobalt (II) chloride hexahydrate and  nickel sulfate hexahydrate.  I have changed my shampoo, face creams, detergent, soaps etc etc but continue to itch like crazy and have the symptoms listed before.

The immunologist feels that I have undifferentiated connective tissue disease and mast cell activation disorder despite blood work that is negative for these conditions.

Over the past year, My ANA and Triptase have been normal. My IGE has been very high- 860-1100. Since December  2012, also have consistently elevated ANC,RDW-CV,ABS mono, CRP and compliment 3&4.

Given the elevated blood work, should we be looking in a different direction than MCAD

Answer
Hello Roxy,
Warm welcome to you!
Please do not confuse MCTD and MCAD. You probably have MCTD. MCAD is completely different condition. Normally ANC, ABS mono are constantly elevated in arthritis patients. But in MCTD acute inflammatory markers like CRP are elevated. Also we see elevated ANA, ESR,CPK, Rheumatoid factor, IgG (not IgE), complement level, sometimes antithyroglobulin antibodies etc. So before coming to diagnosis all these need to be confirmed. Also a chest x-ray and EMG may be needed.

We can even suspect Dermatomyositis. Its a very similar condition. If you wan tyou can get tested for that also. But I think it is MCTD only because in dermatomyositis we see non-itchy rash. And MCDT is often seen in these patients:
Demographics & Risk Factors:
   Population/Female
   Population/Fifties adult
   Population/Middle-aged adult
   Population/Post-menopausal female etc

You can use Tacrolimus/Pimecrolimus creams for uncontrolled itch if corticosteroids didnt work. They are effective.

Thanking you!

Hematology

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Dr.Shrinidhi Kulkarni

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I can answer all questions related to hematology. RBC, WBC, Platelet and blood forming organs etc and related questions. hematology also includes blood proteins, hemoglobin and disorders related to clotting abnormalities. So questions about all aspects of hematology are welcome!

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Working as a Doctor in Primary Health care Centre.

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MBBS, Internship in Internal Medicine

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