[23F] With worsening back pain, sciatica, fever, and systemic symptoms
Patient Description
A 23-year-old female presents with worsening back pain localized to the upper and lower back, primarily around a large disc herniation at L5-S1. The pain is described as sharp, stabbing, and electric, radiating down both legs, accompanied by dull and sharp sensations in the back and pressure extending to the tailbone. The patient reports tingling in the feet, reduced sensation in the right leg compared to the left, and significant weakness in the legs, which has further limited mobility. Sitting, bending over, turning the head, and leaning back exacerbate the pain.
The patient also experiences persistent fever (38.4°C), daily chills, and sweating. Nausea and vomiting have been severe, with an inability to eat or retain fluids. Chronic constipation has worsened, requiring manual stool removal every two weeks, with stools described as hard, large clumps accompanied by mucus and bright red blood. The patient has neurogenic bladder managed with a suprapubic catheter, which is frequently infected alongside the catheter insertion site. Despite being on antibiotics, these infections persist.
The patient has a history of chronic GI dysmotility, irritable bowel syndrome, and neurogenic bladder. She also has a suprapubic catheter due to retention and incontinence. Pain management with Tylenol 3 has been insufficient, and laxatives have proven ineffective for constipation. Chronic conditions include Classical Ehlers-Danlos Syndrome, Functional Neurological Disorder, Chronic Fatigue Syndrome, Fibromyalgia, and others. No recent injuries or diagnostic tests have been performed for the current symptoms. Thyroid function tests were negative despite recent weight gain. No changes in urine color or smell, nor rashes or skin changes, were noted.
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Arora's Assessment
What might be happening
Your symptoms are complex and likely involve multiple underlying issues. Here’s an overview of what might be happening:
1. Worsening Spinal Nerve Compression (L5-S1 Disc Herniation)
- Your MRI findings confirm a large disc herniation at L5-S1, which is compressing the right S1 nerve root and narrowing nerve passages. This explains your sharp, stabbing back pain, electric pain radiating down both legs, tingling, and reduced sensation in your right leg.
- The worsening nerve compression may also be contributing to your limited mobility and difficulty standing or walking.
2. Infection (Suprapubic Catheter Site and Bladder)
- Your fever, chills, and sweating, combined with frequent infections at your catheter site and bladder, suggest a possible systemic infection. This could be a urinary tract infection spreading to the bloodstream (sepsis), or a localized infection at the catheter site.
- Given your history of recurrent infections, this is a serious concern that requires urgent medical evaluation.
3. Severe GI Dysmotility and Constipation
- Your chronic constipation, requiring manual stool removal, is likely related to your GI dysmotility and conditions like irritable bowel syndrome. The presence of mucus and bright red blood may indicate complications such as anal fissures or hemorrhoids.
- Nausea, vomiting, and inability to eat or keep fluids down could be signs of a bowel obstruction or severe constipation, which may require immediate intervention.
4. Systemic Symptoms and Chronic Conditions
- Your fatigue, weight gain, and worsening pain may be influenced by your underlying chronic conditions, including Ehlers-Danlos Syndrome, fibromyalgia, and chronic fatigue syndrome. However, the acute worsening of your symptoms suggests new complications that need attention.
What you can do
Seek Immediate Medical Attention
Your fever, worsening back pain, and neurological symptoms (tingling, reduced sensation, and mobility issues) could indicate serious complications. You should contact your healthcare provider or go to the emergency department as soon as possible. Tests like blood work, urine analysis, and imaging may be needed to evaluate for infections, nerve damage, or bowel obstruction.
Manage Your Back Pain and Nerve Symptoms
While waiting for medical care:
- Avoid positions that worsen your pain, such as sitting, bending, or leaning back.
- Use a lumbar support cushion if sitting is unavoidable.
- Apply ice or heat packs to your lower back for temporary relief.
- Take prescribed pain medications, but avoid exceeding the recommended dose.
Address Constipation and GI Symptoms
- Continue using prescribed laxatives and stool softeners as directed.
- Drink small sips of fluids to stay hydrated, even if nausea persists.
- Avoid foods that worsen constipation, such as processed or high-fat foods.
- If you experience severe abdominal pain, vomiting, or inability to pass stool, seek emergency care immediately.
Monitor Your Catheter Site and Bladder Health
- Keep the catheter site clean and follow your daily bladder protocol carefully.
- Report any worsening redness, swelling, or discharge at the site to your doctor.
- Track your urine output and any changes in color or smell using the MDandMe journal.
What you should look out for
You should seek medical care urgently if you experience any of the following:
- Neurological symptoms: Sudden loss of bowel or bladder control, worsening leg weakness, or inability to move your legs (possible cauda equina syndrome).
- Infection symptoms: High fever, chills, confusion, or rapid heart rate (possible sepsis).
- GI symptoms: Severe abdominal pain, vomiting, or inability to pass stool (possible bowel obstruction).
- Back pain symptoms: Pain that becomes unbearable or spreads to new areas.
Your symptoms are serious and require prompt medical attention. Use MDandMe to journal your symptoms, track progress, and share detailed notes with your healthcare provider. Let me know if you need help preparing for your doctor’s visit or have more questions!
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3 d ago