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Why am I suffering from pleuritic pain?

Q: I am a 43 years old man, has and I have pain in the right lower back side of the lung with a sore throat since 20 days. I took some homeopathic medicines which reduced the pain. After that, I saw blood in my sputum and consulted a doctor who prescribed antibiotics and asked for a blood test and chest x-ray. The blood TLC – 11,800, eosinophil - 46, ESR - average 20.6 and rest all parameters were normal. Chest x-ray shows haziness in the right lower side of lung (pneumonic patch), sputum examination showed no tuberculosis germs. After that, I travelled by road for about 900 km in two days and the pain recurred and the blood test showed TLC- 8,800, eosinophil - 28, ESR average - 12.5 and X-ray showed no change in the patch. Now CT scan of chest also shows haziness. Have I been correctly diagnosed? I have small children in the house, what precautions do I need to take? Can I travel?

A:The description you have given suggests a number of possible conditions. Infections like pneumonia due to bacteria appears to be a very likely possibility . I would be more comfortable treating for tuberculosis with a little more information like sputum culture growing the tuberculosis bacteria since there can be resistance . Also the sputum should be cultured for bacteria and fungal infections.The high eosinophil count can be seen in conditions like eosinophilic pneumonia. Pleuritic pain- the pain in the back of the chest you are describing can occur with inflammation of the lining of the lung or the inside of the chest cavity. It can also occur when there is a pulmonary embolism or blood clot traveling from the legs to the lungs that causes a condition called pulmonary infarction and in that situation also blood in sputum can occur- this will lead to some shortness of breath usually . Given your young age and rapid symptom development it appears that lung cancer is much less likely. I would suggest that you meet with your doctor or your pulmonologist to discuss these possibilities especially if you are not improving . There are other tests for TB also that can be done from the blood which sometimes help with diagnosis like the immune response evaluation . Further investigation with even bronchoscopy or lung biopsy may be required if you are not improving . The pain should get controlled within a week with over the counter anti-inflammatory pain medications like ibuprofen taken as directed by your provider . Eat a balanced diet and exercise as tolerated. You should cover your mouth if coughing and avoid crowds till the diagnosis is confirmed. I would suggest further workup as discussed above.

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