Need some advice on lab results

[leerobert]

My husband received his test results back and all the test were negative except an elevated SED rate of 64. He was also checked for chlamydophilia pneumoniae and mycoplasma pneumoniae which were negative. Negative for adenovirus, coronavirus, influenzas, parainfluenza, RSV, and bordetella pertussis. CMV and parvovirus tests were negative, as well as the ANA tests that were run. CRP is still elevated at 10.6 as of today and his total protein and albumin are low. ALT liver test is elevated at 75, but AST and alk phos are normal. He started this week to retain fluid in his lower legs, not sure if that is from the low protein and albumin or what is going on. Abdominal ultrasound was negative, all organs were normal.

RA diagnosis 2015 - positive anti-CCP. Currently Clarithromycin 500 mg daily; Turmeric supplement; probiotic; fish oil; vitamin D3; MSM. Minocycline therapy from 2015-2017 until developing sensitivities. Gluten free and dairy free diet. Severe dairy intolerance. Tested positive for M. pneumoniae igG

[Maz]

Lee, do you know if the rheumatologist tested for anti-Sm antibodies? Sometimes this is elevated in drug-induced hepatitis. It’s very good that his ANA is negative, however.

Also, when you say his albumin is low, how low do you mean? Does his sodium look okay?

There is a condition called bacterial hypersensitivity that Dr. Brown talked about in a transcription of a talk he gave under the Resources page, where lower leg swelling can be a result of too much bacterial die-off, causing a hypersensitivity syndrome….but it’s prob wisest to rule out drug-induced hepatitis first.

These are just fellow patient ideas and things to consider talking about with his doc, though, and may be irrelevant.

[leerobert]

Hi Maz,

I don’t think anybody tested anti-SM antibodies. I know his regular doctor questioned an autoimmune hepatitis, but it was only mentioned. He sees infection doctor again on Wednesday and we will see what her further plan is. His total protien is 5.8 (normal range 6.2-7.8 for lab here) and his albumin is 3.4 (normal 3.5-5.0 for lab here). Another lab that has been on the low side is his creatine which is .67 (normal .70-1.30 for lab here) which I haven’t read into since its low and not high which means his kidneys must be working good. Did a little looking into this labs and the low protein and albumin can cause fluid retention due to fluids leaking out of vessels, but why is it low? His sodium is normal. I even was questioning a malnutrition issue such as celiac disease. He eats gluten free mostly since I have to follow a GF diet, but still gets the occasional bun or pizza, etc. Labs are probably just off due to whatever he has going on right now.

We did decide last week to stop the minocycline for at least 1 week to try a washout. His last dose was Wednesday and he has been slowly improving. Not sure if it is this bacterial sensitivity that Dr. Brown talked about or if it is DIL. I read that with minocycline drug induced lupus, that ANA tests can be negative sometimes. Would all of them be negative or are this just talking the regular ANA test? I am going to contact Dr. S tomorrow and see what he recommends and we will keep our appointment with infectious doctor on Wednesday.

RA diagnosis 2015 - positive anti-CCP. Currently Clarithromycin 500 mg daily; Turmeric supplement; probiotic; fish oil; vitamin D3; MSM. Minocycline therapy from 2015-2017 until developing sensitivities. Gluten free and dairy free diet. Severe dairy intolerance. Tested positive for M. pneumoniae igG

[Maz]

Hi Lee,

Did you get the list of AP docs in surrounding states okay? I saw you got the “most experienced” AP doc list, so hopefully you’re good with that. If not, then I’ll take a look and see what there is in the way of AP docs, too, in nearby states.

I don’t think anybody tested anti-SM antibodies. I know his regular doctor questioned an autoimmune hepatitis, but it was only mentioned.

This is very likely a good test to run in light of the elevated liver enzymes and just to rule out any chance that mino may be causing “rare,” but possible drug-induced hepatitis. Infections, too, can cause elevated enzymes – when I first got infected with Lyme, it got into my liver in a big way and all my LFTs were elevated. Within a month of high dose combination abx, though, these all normalized. Additionally, something as simple as a sludgy gall bladder or stuck gall stone can lead to elevated LFTs. I’ve used milk thistle in the past, which is great for liver detox….there are other options, too, but just smart to run the tests for DIH.

He sees infection doctor again on Wednesday and we will see what her further plan is. His total protien is 5.8 (normal range 6.2-7.8 for lab here) and his albumin is 3.4 (normal 3.5-5.0 for lab here).

Yes, this may just be a temporary blip, but something to watch. I think when it dips below 3 is when docs begin to worry.

Did a little looking into this labs and the low protein and albumin can cause fluid retention due to fluids leaking out of vessels, but why is it low? His sodium is normal.

Yes, it’s my limited understanding, too, that fluid build-up in lower legs can be related to low albumin, but there could be any number of answers. My guess would be that the doc would look for a downwards trend over time, but hopefully this is just a minor a blip, as you say.

I even was questioning a malnutrition issue such as celiac disease. He eats gluten free mostly since I have to follow a GF diet, but still gets the occasional bun or pizza, etc. Labs are probably just off due to whatever he has going on right now.

Is your hubby losing weight? Celiacs can often be underweight with malabsorption issues. It’s easy enough to test gliadin ABs, if you’re concerned. However, gluten intolerance is a different matter – it’s actually less the gluten and more about zonulin which causes gluten intolerance and a person would need to be off all gluten for a good few months (even hidden gluten in processed foods, alcohol, breads, etc.) to know if it’s making a difference to how they’re feeling. One really needs to become a label-reader.

Gluten, Inflammation and Leaky Gut in Rheumatic Diseases

We did decide last week to stop the minocycline for at least 1 week to try a washout. His last dose was Wednesday and he has been slowly improving. Not sure if it is this bacterial sensitivity that Dr. Brown talked about or if it is DIL.

Yes, if you’re concerned about DILE, then the only way to know for sure is to be tested.

I read that with minocycline drug induced lupus, that ANA tests can be negative sometimes. Would all of them be negative or are this just talking the regular ANA test?

If the ANA test is negative, then this is a good thing…it’s a first-line type of screening test, which is done in doubled-dultions: 1:40, 1:80, 1:160, 1:320, 1:640, 1:1280, etc. So, if a person jumps up a number, it can be nerve-wracking, but it’s worth noting that it just means one level up. For DILE, the ANA can be positive (not always), but would present with a homogenous pattern. On it’s own, ANA isn’t a great test for DILE, unless it’s always been negative, but suddenly goes positive, with symptoms of DILE, and other labs to support the diagnosis (anti-histone ABs and single-stranded anti-DNA aka SS anti-DNA). The ANA a weird test, because it can also be positive in perfectly healthy people, but also in other diseases, like MS.

I am going to contact Dr. S tomorrow and see what he recommends and we will keep our appointment with infectious doctor on Wednesday.

Please let us know how you guys get on, Lee, and sending all good wishes. Not to panic is mino is out for your hubby….there are other abx possible for use for RA, but usually it needs an experienced AP doc or LLMD to help with this.

[leerobert]

Just wanted to give an update. Husbands fever is completely gone now after quitting the minocycline. He has been off medication for 1 week. He still has some edema around his ankles and arthralgias in his ankles and knees, but is a little bitter. We seen infectious disease doc yesterday and when we told her we had stopped the antibiotics and his fever went away she definitely thinks its the minocycline, so like a drug induced lupus syndrome or she also worded it a “drug fever”. My husband wants to rechallenge the mino, but neither ID or his rheumatologist want him taking it again. I am starting to wonder if the pneumonia back in August was drug induced also. Now we need to figure out our next options. We are hoping he can maybe take doxycycline. Has anyone had luck with doxy who developed DILE with minocycline?

Tried calling Dr. S on Tuesday with no luck. I also have sent an email. Hoping I can get a hold of him today.

RA diagnosis 2015 - positive anti-CCP. Currently Clarithromycin 500 mg daily; Turmeric supplement; probiotic; fish oil; vitamin D3; MSM. Minocycline therapy from 2015-2017 until developing sensitivities. Gluten free and dairy free diet. Severe dairy intolerance. Tested positive for M. pneumoniae igG

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