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Dr. Andrew Rynne

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What causes pain in the ribs despite being on Levoquin for pneumonia?

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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3064 Questions

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Posted on Thu, 4 Oct 2018 in Ear, Nose and Throat Problems
Question: had sinus infection couple days after finishing antibiotics i got pain in right ribs. specialist said it was not my fibromyalgia it is pneumonia refilled 10 days of levoquin and gave me a medrol dose pack have been taking for 5 days and don't feel better
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Answered by Dr. Bonnie Berger-Durnbaugh 44 minutes later
Brief Answer:

Questions so that I can advise

Detailed Answer:

Hello,

I have a few questions so that I can get a better idea of what might be going on:

1. I take it you were on Levoquin before the rib pain started?

2. What kind of specialist told you it is pneumonia?

3. Did the doctor diagnose this based on an X-ray? Was an X-ray taken?

4. What other symptoms did you have (other than the rib pain) when you were diagnosed with pneumonia - fever? coughing purulent sputum throughout the day?

5. What was the time sequence between finishing the Levoquin and the onset of the rib pain?

6. Please describe the rib pain:

Does it hurt to touch it?

Does movement such as twisting the chest wall or arms increase the pain?

Is there pain under the right rib cage?

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 31 minutes later
yes took ten day then a couple days later the rib pain started my pain specialist after listening to my lungs. said something like roakke sounds no xray not coughing up. I think I had a fever 3 days hurts to touch-sharper pain. ribs hurt to move,breathe, and go to the bathroom seems to be better when my arms are out like opening my chest
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Answered by Dr. Bonnie Berger-Durnbaugh 26 minutes later
Brief Answer:

Information

Detailed Answer:

I don't have the advantage of an exam and knowing what your lungs sound like (possibly he said raunchy?)

But there are a few things here that concern me.

Pneumonia does not cause tenderness to touch or pain with musculoskeletal movement (other than sometimes with the movement of the lungs such as a deep breath - both musculoskeletal problems and lung/pleuritic problems can cause that).

If you were coughing a lot before the rib pain started, it may be a fracture.

If you were not coughing a lot, it could be the Levoquin. Antibiotics in the fluoroquinolone family (Cipro, Levoquin, Ofloxacin) can have strange side effects of tendonitis and other musculoskeletal problems.

Also, if pneumonia truly followed a sinus infection for which you were being treated with an antibiotic, you wouldn't want to repeat that same antibiotic because most likely it wasn't effective.

Here is what I recommend at this point:

1. Go back in to be seen, to an urgent care clinic today if you don't think you can get in to see your primary care doctor tomorrow.

2. Request a chest X-ray. If there was pneumonia, it will still likely be visible even if symptoms mostly resolved. If there is a fracture, it should show up.

3. Make sure to be seen by a doctor (request one specifically when you talk with the receptionist) not a PA or NP. The doctor will examine your rib cage and listen to your lungs.

Before he/she listens to your lungs, have a big cough and clear out any mucus.

Sometimes when there is some mucus (not from infection necessarily) it can sound like rhonchi and not be pneumonia or bronchitis. A cough before the doctor listens can clear this out.

4. Ask whether the doctor thinks the Levaquin is absolutely necessary.

If/when you go into the urgent care, please make sure not to touch your eyes or nose with your hands unless you have just thoroughly washed or alcohol gelled them and touched nothing else in between, as you don't want to pick up anything else there.

Hope I have answered your query.

Take care

Regards,
Dr Bonnie Berger-Durnbaugh, General & Family Physician
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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