Evaluation for Sjogren’s syndrome and lymph node biopsy?

I have Hashimoto’s Disease but, besides the Legionella diagnosis (which don’t explain all my symptoms); I have no other explanations for my symptoms since November 2008. I have taken several antibiotics but it doxycycline heclate worked very well to clear up most of my symptoms.


I was diagnosed with Legionella this past week by Roswell Park Infectious Disease Department via a blood test by EIA. In addition to the Legionella diagnosis, the following flags have also been raised: Mycoplasma exposure, high Eisinophils, high sed. rate, etc. My symptoms over the months since November 2008 have been: 


  • (11/2008) Itchy scalp, rash on inner thighs, congestion, double ear infection, nose sores, red eyes, swollen lymph nodes behind ears
  • (12/2008) Scaly rash on face, excessive vaginal discharge, rectal rash, rash under breasts, excessive bleeding in mouth while/after brushing, swollen neck lymph nodes, angular cheilitis, rash on neck
  • (1/2009) Rashes in armpits, arm rashes, foot dryness, sores on back-arms-ears, scalp flaking, ear dryness, hand rash, lesions on finger tips, crusty and oozing belly button
  • (2/2009) Blood when voiding, cracks on ears, hand rash, genital and rectal rash with discharge and foul smell, lumps on vaginal labia, pelvic region sensitivity, itchy feet, angular cheilitis, slight scalp flakiness
  • (3/2009) Swollen lymph nodes in neck size of golf balls, severe coughing which results in vomiting phlegm-blood-food, diminished appetite, weight loss (20 lbs) (4/2009-7/2009). Severely dry eyes that stick, almost seal closed and more of the same as listed
  • (7/2009) Was put on Doxycycline Heclate and all symptoms improved – not totally gone but definite improvement
  • (8/2009) Stopped Doxycycline Heclate and vaginal and rectal rash and discharge returned to a lesser degree but still back, swollen lymph nodes in neck smaller but still there, had a pain in my left leg (now is gone), have a rash on face-back of neck/between breasts/back/armpits, itchy scalp, and belly button crusty and oozing


So, my questions are:
Do I have Legionella?
Should I pay to have my private residence water checked for Legionella pneumophila?

The information that you have provided is insufficient to definitively answer your question. Was a chest x-ray ever performed? What is the precise number for your sed. rate and eosinophilia?

The symptoms that you describe are consistent with Sjogren’s Syndrome which should be evaluated. This malady has been linked to Hashimoto’s. The larger lymph node might be biopsied to rule out other more serious diseases.

With respect to culturing your drinking water, this probably will be less useful in your specific case. Doxycycline is curative for Legionella (and Mycoplasma pneumoniae) and we have found that recurrent Legionnaires’ disease almost never occurs. The first attack apparently confers some immunity. The second reason is that the sources of drinking water are numerous, and your home may not be the source. Regardless, we could culture your drinking water, but I think you may be protected by your first episode. However, if you ever require steroid therapy in the future, the info about Legionella in your drinking water may be useful. The cost for the Legionella cultures is not high; we will perform it gratis in your unique case, but we do request that you pay for shipping charges.

Your next step: See a rheumatology specialist for evaluation of Sjogren’s disease. And ask for his/her opinion of a lymph node biopsy – if the lymph nodes have regressed back to normal size than it is ok not to biopsy. Please keep us posted, but your Legionnaire’s disease appears to have been cured.