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Suggest Treatment For Lower Back Pain, Jaw And Neck Stiffness

Posted on Wed, 31 May 2017

Question: Hi, I'm a 25 year old male, I've been having health issues for 7 years. My problems started after an infection that was not treated in any way. Immediate symptoms were fever, cough (several months), horrible headache that persisted for years. Lower back pain, lumps on the back of the head, lump in the lower back region, small lump on the penis... Later symptoms - lower right abdomen pain and discomfort, jaw stiffness and cracking, neck stiffnes.
I did all sort of immunological testing ,MRI (maxillary sinus cyst, spondylosis), ECG extrasystole.
After a month of oral Doxycycline and a month of Clindamycin, most of the localized pain (eye, forehead, abdomen) disappeared.
My immunologist suggested that it could be Lyme disease, because of the fact that it appeared in ELISA test with a borderline value (though technically negative), infectologist negated that claim

I'm living in a 3rd world country where diagnosis and treatment are almost literally non-existent. My question is, what bacteria would you advice me to test? From my limited knowledge and almost XXXXXXX search through the internet, the closest I was able to get is a something like secondary arthritis that would fit the description of what I'm experiencing

Present symptoms jaw crackling, neck stiffness and crackling, lumps (lumps retreated initially from oral Clindamycin therapy) and than re-appered after ending the therapy, lower back pain (around the lump), discomfort and pain in the right hip area

Please advice on what I should do. I've been suffering for many years and I'm kinda desperate.

Regards

Answered by Dr. Dr. Muhammad Sareer Khalil (2 hours later)

Brief Answer:
Excisional biopsy of the lump

Detailed Answer:
Hello and Welcome

I appreciate your concern

The lumps need to be biopsied. There is no point in looking for a specific bacteria and treating it thereafter unless a histo pathological tissue based diagnosis is not achieved. An excisional biopsy would be required to remove one of the lumps and determine its nature.

Blood cultures can be done to rule out any bacteremia associated with the illness. The cultures should be taken off the antibiotics.

An ultrasound abdomen pelvis and urinalysis should also be done. Complete blood count, ESR/CRP levels, and chest x-ray would also be needed to get a more clear picture.

Wishing you best of health

Thanks

Let me know if you have any query, I'll be glad to clarify further.

Please consult your doctor before deciding on any further course of action.

For future follow up/correspondence you may ask me directly at the link given below

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68107

Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Muhammad Sareer Khalil (1 hour later)

Dr. XXXXXXX

Thanks for the quick and precise answer.

CRP (not hsCRP) and ESR were far bellow the threshold last time I tested. The only thing that was slightly increased ALT almost every time it was tested. Abdominal ultrasound showed no abnormalities. All of the tests for an autoimmune disorders are negative

Some additional info and a question

Typically, holding the same position- be it head/neck, arm or leg for more than a few minutes would give me horrible pain in that area. If I was to stay awake all night sitting at the computer which I rarely do, I would have a feeling of my muscles and tendons falling. After a month of Clindamycin I was able to stay in the same position for a longer period of time with noticeable reduced pain

Question

Do you think it makes sense to try a therapy with IV Clindamycin, taking into account that there was a positive reaction (retreating lumps, reduced swelling in the forehead area, reduction of localized pain) prior to excisional biopsy?

Thank you

Answered by Dr. Dr. Muhammad Sareer Khalil (9 hours later)

Brief Answer:
Explained

Detailed Answer:
Hello again.

Prolonged Clindamycin use can predispose to pseudomembranous colitis which is associated with overgrowth of bacterium Clostridium Difficile.

However, if you want to give the antibiotics a try before going for the biopsy to see if it resolves the condition then you can consult your doctor.

My opinion would be to get the biopsy done, first.

Thanks

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Muhammad Sareer Khalil (3 hours later)

Last question-

My current therapy prescribed by my doctor is 28 days of oral Clindamycin ( 2 weeks 3x 300mg a day + 2 weeks 2 x 300mg a day)...Would that classify as prolonged Clindamycin use? In your experience is that enough to get Clostridium Difficile overgrowth or is it relatively safe?

Thank you so much!

Answered by Dr. Dr. Muhammad Sareer Khalil (1 hour later)

Brief Answer:
Explained

Detailed Answer:
Hello again

A five day course can cause it even during antibiotics therapy.

Symptoms of C. difficile like diarrhea may begin during antibiotic therapy or a few days after the antibiotic is stopped.

If you get watery diarhhea then contact your doctor to stop the clindamycin and test for c diff.

Thanks

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Above answer was peer-reviewed by : Dr. Vaishalee Punj