OpenHealth Q&A

Initial Relief from Ceftriaxone Followed by Recurring Symptoms

A 32-year-old female with bipolar disorder presents with a history of kidney stones, linked to her use of Lamictal, as well as acid reflux caused by a hiatal hernia, for which she manages with Pantoprazole. In mid-May, she experienced the passing of a kidney stone at home without seeking emergency care. The pain she felt was significantly severe, reminiscent of labor contractions, similar to the first instance when a stone was detected via CT scan at the ER. On May 21, she was admitted to the hospital for a four-day stay due to pneumonia resulting from a viral infection. During her stay, she reported experiencing back pain, which led to a CT scan for potential kidney stones; instead, doctors identified aspiration bronchitis. She was treated with azithromycin along with an intravenous antibiotic, the name of which she cannot recall but suggests it starts with an “R.” When inquiring about a prescription for oral antibiotics upon discharge, she received a positive response, although none were ultimately prescribed. She was not overly concerned about this, as she has other medications to manage, complicating her access to the pharmacy benefits under Texas Medicaid. On the night of May 30, she began to feel gut discomfort and various urinary symptoms, though not the severe pain typically associated with urinary tract infections (UTIs). The urgency could be misleading since chronic urinary issues have persisted since her teens, with fluctuating degrees of severity, calling for a future evaluation by a urologist—potentially interstitial cystitis (IC). Interestingly, she noted that phenazopyridine seemed to alleviate the gut pain. As her lung symptoms resurfaced, she sought help at an urgent care facility. An X-ray showed no abnormalities, but a urinalysis indicated bacterial presence in her urine, leading to a seven-day prescription of Levaquin. Days following the completion of antibiotics saw her lungs improving, but ongoing gut, pelvic, and back pain prompted another visit to urgent care, where the physician opted for a urine culture instead of a new antibiotic, agreeing that certainty of its effectiveness was paramount. Five days later, she learned that her urine culture yielded negative results, yet her discomfort persisted, accompanied by severe back pain and sporadic, painful muscle spasms. A urine test at the clinic confirmed no bacterial infection, and the doctor advised a primary care physician visit, which posed a challenge since her assigned doctor wouldn't be available until July 1. Nonetheless, the doctor ordered blood tests, which returned normal except for slightly elevated liver enzymes needing further assessment. In a sudden realization that her husband had cheated without informing her until March, she suspected an STD could be responsible for her symptoms. Returning to urgent care, a different provider administered a single 1g injection of Ceftriaxone and arranged tests for STDs. Approximately 36 hours later, she noted some improvement: gut, pelvic, and back pain had diminished to occasional mild discomfort, allowing her to cease taking phenazopyridine and non-steroidal anti-inflammatory drugs (NSAIDs). Following the initial relief, some test results arrived indicating no BV, yeast infections, chlamydia, or gonorrhea. Yet, about 36 hours post-injection, her debilitating pain returned, mirroring her pre-treatment condition. She has not yet received results for some of the other tests. Throughout this episode, she did not experience diarrhea, nausea, vomiting, or fever. For context, she has endured labor and kidney stone pain, but the current sensations feel more like an internal inflammation rather than an acute abdominal distress associated with anxiety. All evaluated physicians confirmed that appendicitis is unlikely given her symptoms. At this point, she is seeking input regarding her situation but is preoccupied with relocating from the home she shared with her husband for five years. Consequently, she intends to defer seeking medical help unless her condition becomes dire or incapacitating, hoping to see her primary care doctor on July 1.

Answers (1)

6/27/2025, 7:10:55 AM

OpenHealth AI

It sounds like you're experiencing a complex mix of ongoing discomfort and symptoms following a recent series of health challenges, including pneumonia, potential urinary issues, and the emotional impact of personal circumstances. Your main concerns seem to revolve around persistent gut, pelvic, and back pain without clear diagnosis or resolution. Let's address your situation clearly.

Main Points:

1. Symptoms Overview: You’re facing recurring pelvic, gut, and back pain with a history of potential urinary issues, following treatment for pneumonia.
2. Recent Treatment: You received Ceftriaxone, which initially provided some relief, but your pain has returned.
3. Appointment Concerns: You plan to see your primary care doctor on July 1, but are managing your symptoms in the meantime.

Explanation:

The symptoms you're describing could stem from several interconnected issues: chronic urinary pain, possibly related to interstitial cystitis, persistent inflammation, or post-infectious symptoms following your recent pneumonia treatment. The initial improvement after the Ceftriaxone injection suggests a possible contribution from infection or inflammation that may not yet have been fully addressed. It's important to consider factors like emotional stress, potential anxiety, and how they can interact with physical symptoms.

Next Steps:

1. Symptom Management:

   • Hydration: Continue to stay well-hydrated, as this can help minimize irritation in the urinary tract.
   • Pain Relief: Use over-the-counter NSAIDs cautiously, keeping in mind your history of kidney stones and any gut discomfort. If NSAIDs aggravate your symptoms, explore acetaminophen as an alternative.
   • Comfort Measures: Try warm baths or heating pads on your abdominal area to help ease muscle tension and discomfort.

2. Monitoring Symptoms:

   • Symptom Diary: Keep a detailed log of your symptoms, noting when they occur, their intensity, and any potential triggers. This can help your primary care provider make informed decisions.
   • Identify Patterns: If you notice symptoms relate to certain activities, foods, or stressors, note these in your diary for future reference.

3. Follow-Up Testing:

   • Await Test Results: Make sure to follow up on any outstanding tests regarding STDs and other potential causes of your symptoms. This information will be crucial for ongoing management.
   • Return to Care: If symptoms worsen or new concerning symptoms arise (e.g., severe pain, fever, significant changes in urination), consider visiting urgent care again prior to your July appointment.

4. Emotional Health:

   • Given the emotional stress from your recent personal circumstances, consider incorporating stress-management techniques, such as mindfulness or relaxation exercises. These can help you cope better with your physical symptoms.

Conclusion:

Although waiting until July might seem manageable, be attentive to how your body reacts in the upcoming weeks. Seeking help sooner if symptoms escalate can be beneficial. You are not alone in navigating this, and taking time for self-care both physically and emotionally is key. Reach out if you have further questions or need clarification on any points!