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Lung diseases

Sarcoidosis/Whooping Cough?

08/24/2010

Question:

Hi, My husband was confimred as having whooping cough in early to mid May this year (2010), since then, he seems to have developed a different, more chesty cough. He had a chest X-Ray, normal. He had a chest CT, it reads, cr examinationo f the chestw ith high resolutionr econstructionwse re per formed.T herei s evidenceo f groundg lasso paci f icat ioans wel la s mi ld paraseptailn terstitiatlh ickeningp resent,T his involvesb oth apices.T herei s f inen odular i tyn oted. No massl esioni dent i f ied.C alci f iedn odulen otedi n the r ighti s thoughtt o be an old granulomatounso dule. Therei s no evidenceo f signi f icanmt ediast inaolr hi larl ymphadenopathy shown. No pleurael f fusiond emonst ratedT. hea drenagl landsa ppear satisfactory. CONCLUSION Abnormality present associated with both upper lobes with fine nodules as well as mald increased interstitial thickening. This could represent atypical mycoplasma infection. Other atypical pulmonary infection could also be considered. Sarcoid would be a less likely possibility. Clinical correlation as well as follow up is advised. The pulmonary nodule noted in the right mid zone is old granulomatous focus.

Last week, he had a broncioscopy, the thoracic specialist said that he didn`t find anything and that the backwash that was sent to pathology did not show any infection or cancerous cells. He suggests a lung biopsy and insists that it`s sarcoidosis, even though all blood tests etc do not show sarcoidosis. We are very confused, as our referring GP said that whoopping cough could present like this on a ct scan and it`s only August, so the cough is probably still due to whooping cough - the cough now comes mainly at night or early in morning, no phlegm but dosn`t sound like a traditional whooping cough. My husband is 41 and he did smoke some years ago. Any help would be appreciated as we have no idea what to do from here? Thanks

Answer:

Dear Madam- The chronic cough and radiographic changes certainly could be related to sarcoidosis. Whooping cough (Bordetalla Pertussis) can cause pneumonia and chronic cough; however, the lung nodules in the upper lobes of the lung would be unusual. Other possibilities, as mentioned by the radiologist, should also be considered.

Given the abnormal radiographic findings and the long duration of symptoms, a bronchoscopic biopsy (a relatively low-risk outpatient procedure) would be very reasonable. Note that there are no reliable blood tests for sarcoidosis and a biopsy is the best test.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University