OpenHealth Q&A

Months of Illness Following Imuran Treatment for Lupus

**Age:** 24, **Weight:** 128 pounds, **Height:** 5'6", **Ethnicity:** Caucasian, **Lifestyle Choices:** Never smoked, abstained from alcohol, never engaged in recreational drug use. For those who wish to grasp the full scope of my experience, I encourage you to read on, though here’s a brief summary: **Summary:** Since initiating Imuran (Azathioprine) for a week in May 2025, I have been plagued by unrelenting burning pain in my upper abdomen. Other troubling symptoms have emerged progressively, including severe anxiety, temperature fluctuations, excessive sweating, clamminess, nausea, overwhelming fatigue, emotional instability including mood swings and crying spells, persistent headaches along the top right of my head, vertigo, visual disturbances, weakness on my right side, memory difficulties, brain fog, and night sweats. **Medication and Supplements:** - **Medications:** 200mg Plaquenil twice daily, 75mg Sertraline (increased from 50mg recently), 200mg Progesterone daily (withhold during menstruation). - **Diagnoses:** Lupus (diagnosed May 2025), anxiety and depression since 2014 (diagnosed), suspected endometriosis (heavy and painful periods, diagnosed circa 2022). - **Supplements:** Olly Ultra Strength Sleep Softgels, Diindolylmethane (DIM) 300mg. Having received a lupus diagnosis nearly two years ago, I have been relying on Plaquenil (Hydroxychloroquine) for about the same duration. While it alleviated some flare-up symptoms, I still did not feel entirely well. Consequently, I consulted my rheumatologist about introducing an immunosuppressant and was prescribed Imuran at 50mg twice daily, commencing on May 15, 2025. Within days, I became severely unwell, experiencing dizziness, intense nausea that confined me to bed, loss of appetite, fatigue, abdominal pain, and diarrhea. I discontinued Imuran after eight days as my condition was unbearable, though the burning pain in my upper abdomen remains, varying in intensity. During that time, I lost ten pounds. In June 2025, I experienced a significant exacerbation of upper abdominal pain, accompanied by intractable nausea and inability to eat, amplified anxiety (prompting an increase in sertraline), diarrhea, bloating, clamminess, fever-like sweats, tremors, and excessive belching. Concerned about the possibility of pancreatitis, I sought urgent care, but tests revealed my lipase levels were normal. I did have a notable resting heart rate of 107 bpm and a low temperature of 96.6°F. Laboratory tests indicated normal glucose and kidney function, but I was diagnosed with gastritis, receiving a prescription for omeprazole, which ultimately exacerbated my lupus symptoms, leading me to discontinue. In August, I underwent routine bloodwork, results of which I scarcely remember (due to memory issues) included stable counts across various measures such as RBC, hemoglobin, and WBC. However, I also had an elevated count of lymphocytes and a low Eosinophil count flagged. In September, I treated a UTI with Cephalexin. On Halloween, I fainted while curling my hair, a second fainting episode occurred during a cooking incident in June. On November 11, 2025, I suffered an episode characterized by severe anxiety, intense nausea, loss of appetite, tremors, burning stomach pain, and alternating hot/cold sensations. This time, I visited another urgent care facility where gastritis was once again diagnosed, leading to a prescription for famotidine and dietary recommendations. Although famotidine initially alleviated my stomach pain, it was short-lived and I experienced the onset of a headache thought to be nerve-related along with back and shoulder discomfort. Then, lasting panic attacks occurred for an exhausting six hours, ceasing only after stopping the famotidine. Existing symptoms escalated, with new issues popping up — dizziness where it felt as if my brain was excessively inflating, a persistent linear headache, loss of balance, memory lapses, emotional disturbances including heightened anxiety and irritability, and neurological symptoms like visual snow impairing my sight. I noticed a strange connection between my abdominal pain and my digestive system, discovering that drinking ice water heightened the discomfort, which seemed to originate from a different location than previously noted. Fast forward to December 8, I finally visited my doctor after much hesitation, fearing my neurological symptoms, and was diagnosed with Gut Candida Overgrowth believed to have arisen due to Imuran usage. I received prescriptions for Meclizine for dizziness, Zofran for nausea, and Fluconazole. I adhered to a strict antifungal and candida diet with notable improvements, though some days I felt ill following Fluconazole. By early January, while trying to reintroduce normal foods, my symptoms resurfaced. After a family tragedy in early January with the loss of my dog, I deviated from the diet and my well-being declined significantly. Although I initially weighed about 140 pounds, my weight dropped to 120 because of my health challenges and dietary restrictions. My experience consulting a nutritionist was disappointing due to unhelpful recommendations. By January 13, I sought further information, exploring supplement options for Candida management. I have since incorporated a variety of supplements into my routine, yet despite efforts, my situation remains dire. My symptoms recur despite following a diligent regimen, causing distress and impacting my mental health. My current assessment positions the burning upper abdominal pain as potentially unrelated to gastritis. I pushed my doctor to arrange a GI Map test for definitive clarity regarding candida, alongside bloodwork that recently indicated some low levels while ESR and CRP remained normal. Results for how lupus is currently impacting my health are still pending. I am reaching out for guidance. I am putting forth every effort towards my health recovery, yet my body seems to rebel against me. This year has been arduous, and I am in dire need of insights or potential explanations for my distressing symptoms. Any advice would be greatly appreciated, as my situation continues to weigh heavily on both my physical and mental well-being.

Answers (1)

3/4/2026, 7:01:18 AM

OpenHealth AI

I'm truly sorry to hear about the challenges you're facing with your health. It sounds like a very distressing experience, and I appreciate your willingness to share the details.

You're dealing with multiple symptoms that emerged after starting Imuran and many interactions with medications and dietary changes. Based on what you've described, there are a few important areas we can focus on to address your health concerns.

Main Points:

1. Complex Symptomatology: Your symptoms are multifaceted and may involve gastrointestinal issues, neurological effects, and psychological distress.
2. Potential Medication Side Effects: Imuran can lead to side effects, including gastrointestinal upset and possibly influencing your mental health.
3. Lupus Management and Monitoring: Continuous monitoring of your lupus and related symptoms is essential.

Explanation:

Your history indicates that the onset of symptoms coincided with the introduction of Imuran. The abdominal pain, nausea, and gastrointestinal issues could be linked to medication side effects or an underlying condition, such as gastritis or candida overgrowth. Additionally, the anxiety and neurological symptoms may relate to both your pre-existing mental health conditions and these ongoing physical issues.

While it’s positive that you’re actively addressing your candida concerns, the fluctuation in your diet and possible medication interactions might complicate your recovery, contributing to the weight loss and persistence of symptoms.

Next Steps:

1. Track Symptoms and Triggers:

   • Keep a detailed diary of your symptoms, noting the timing, duration, and any potential triggers (food, stress, medications). This can help you and your healthcare provider identify patterns and adjust treatment as needed.

2. Focus on Diet:

   • Continue the antifungal diet, but aim to reintroduce foods gradually, monitoring your reactions. Nutrient-dense, easy-to-digest foods may help prevent further gastrointestinal distress while supporting weight maintenance.

3. Engage with a Healthcare Team:

   • Request a multidisciplinary approach involving a rheumatologist, gastroenterologist, and possibly a psychologist or psychiatrist to help manage both your physical and mental health. They can help re-evaluate your medication regimen and consider alternatives that might minimize side effects.

4. Stay Hydrated and Manage Stress:

   • Prioritize hydration, especially during flare-ups. Incorporate stress-reduction techniques such as mindfulness, gentle yoga, or meditation to assist with anxiety and emotional disturbances.

5. Regular Follow-Ups:

   • Ensure continuous follow-up appointments to monitor your lupus, assess symptoms, and adjust treatment as necessary. Communicate openly about your ongoing symptoms and any concerns you might have.

6. Seek Support:

   • Engaging with support groups or connecting with others experiencing similar health challenges can provide emotional support and practical advice.

It’s essential to work together with your healthcare providers to navigate these complex symptoms. Each step you take is valuable towards understanding your health better and achieving improvement, so don’t lose hope. If your symptoms worsen significantly, re-evaluate your current management plan urgently. Please let me know if there are specific areas you'd like to focus on further.