[18F] Experiencing severe back pain, urinary symptoms, and systemic signs of infection

Patient Description

An 18-year-old female presents with severe lower back pain that is sharp, throbbing, and shooting in nature, and has been constant for at least three weeks. The pain sometimes travels up the back and is not relieved by any activities or movements. The patient also reports pain in the sides and lower stomach, alongside a constant need to urinate, pain during urination, and a feeling of bloating that is more pronounced in the upper abdomen. Additionally, the patient experiences systemic symptoms including feeling cold during the day with episodes of waking up at night sweating and overheated, a lack of energy, tiredness, and a lack of appetite accompanied by nausea. The patient has been experiencing these symptoms for approximately three weeks and has also noticed a recent pattern of weight loss followed by bloating. The patient reports constant thirst and dry mouth, especially at night. There is no known history of chronic illnesses or conditions, but recent blood work indicated some sort of inflammation or infection. The patient has been prescribed cephalexin and nitrofurantoin mono/mac to treat symptoms suggestive of strep throat and a urinary tract infection, despite negative test results for the latter. The patient has a known allergy to penicillin but has not been exposed to it since childhood. No other medications are reported.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are several possibilities:

  • Urinary Tract Infection (UTI): This is an infection in any part of your urinary system, which includes your kidneys, bladder, ureters, and urethra. UTIs are more common in women, and they can cause symptoms like a constant need to urinate, pain or a burning sensation during urination, lower abdominal pain, and lower back pain. However, you mentioned that your UTI test was negative.

    • Treatment for a UTI typically involves antibiotics to kill the bacteria causing the infection.
  • Kidney Stones: These are hard deposits made of minerals and salts that form inside your kidneys. They can cause severe pain in your back and sides, below your ribs, and radiating to your lower abdomen and groin. Other symptoms can include persistent need to urinate, pain during urination, and nausea.

    • Treatment for kidney stones varies depending on the size of the stone. Small stones can often pass on their own with plenty of fluids, while larger stones may require medical intervention.
  • Gastroenteritis: This is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites. It can cause symptoms like nausea, vomiting, diarrhea, abdominal pain and cramping, bloating, and loss of appetite.

    • Treatment for gastroenteritis usually involves rest, hydration, and over-the-counter medications to relieve symptoms.
  • Hyperthyroidism: This is a condition in which your thyroid gland produces too much of the hormone thyroxine. It can accelerate your body's metabolism, causing unintentional weight loss, increased thirst, sweating, and irritability.

    • Treatment for hyperthyroidism can include medication, radioactive iodine, and sometimes surgery.

Please note that these are only possibilities and not a definitive diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis and treatment.

What you can do

  1. Continue taking the antibiotics as prescribed by your doctor.
  2. Stay hydrated, especially if you're experiencing increased thirst and frequent urination.
  3. Rest as much as possible to help your body recover.
  4. Avoid any foods or drinks that seem to make your symptoms worse.
  5. Keep a symptom diary to track your symptoms, which can help your healthcare provider make a diagnosis.

What you should look out for

Seek immediate medical attention if:

  • Your symptoms get worse or don't improve after a few days.
  • You have severe abdominal or back pain.
  • You have a high fever.
  • You're unable to keep down fluids due to vomiting.
  • You notice blood in your urine or stool.

Remember, it's important to consult with a healthcare provider for an accurate diagnosis and treatment.

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11 mo ago

People Also Ask


What are the common symptoms of a urinary tract infection (UTI)?

Common symptoms of a UTI include a strong, persistent urge to urinate, a burning sensation when urinating, passing frequent, small amounts of urine, cloudy or strong-smelling urine, and pelvic pain in women.


How can kidney stones be treated and what are their symptoms?

Kidney stones can cause severe pain in the back and sides, below the ribs, and radiating to the lower abdomen and groin. Other symptoms include persistent need to urinate, pain during urination, and nausea. Treatment varies; small stones may pass on their own with increased fluid intake, while larger stones may require medical intervention such as lithotripsy or surgery.


What are the signs of hyperthyroidism and how is it treated?

Signs of hyperthyroidism include unintentional weight loss, increased appetite, rapid heartbeat, sweating, nervousness, and irritability. Treatment options include antithyroid medications, radioactive iodine therapy, and sometimes surgery to remove part or all of the thyroid gland.


What should I do if my symptoms worsen or don't improve?

If your symptoms worsen or don't improve, seek immediate medical attention, especially if you experience severe abdominal or back pain, high fever, inability to keep down fluids, or notice blood in your urine or stool.


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2 Comments


Anonymous#56844

4 mo ago

Wow. Reading that was like it was written about what I’m going through currently. I have a 6mm kidney stone blockage. Ureter stent placed almost a month ago. I was in the hospital for 5 days and they did all sorts of tests. Came back I had EColi, a UTI, and some viral infection. Was put on antibiotics for 10 days. Yesterday I went to see my family doc. Follow up appointment. Just coincidentally started having severe pain shooting from my glute muscles up my back and sides through my shoulder and neck. I can’t even sit or lay to be comfortable. Feels like my body is burning from pain and throbbing. Going pee not only burned but shooting pain on left kidney area where stent is placed. Urine and blood analysis came back- I have ANOTHER infection. Waiting on culture to be sure of type of infection. Dr prescribed me Ciprofloxacin which I have now read was black booked by the FDA. :(

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Billy#3955

4 mo ago

Sorry it's happening all over again! I work in healthcare and we prescribe ciprofloxacin for complex UTIs for broad coverage and patients usually do great!

The black box warning is about:

  • Tendon issues (more common in people over 60)
  • Nervousness/agitation
  • Very small risk of damage to nervous system or cardiovascular system but typically only relevant if you have existing risk factors or rare conditions
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