Recurring infections?

[Menno1525]

Hi. I have been on steroids since last April - currently 10mg daily - for suspected GCA (tests were inconclusive so going on initial symptoms and response to medication) . Have been reasonably well and side effects limited to some fatigue and weight gain. However in the month or so before Christmas my inflammation markers (which had been dropping to near normal) started rising again, though not excessively, and my rheumatologist ordered some urine tests which seemed to indicate I had a UTI , although I had no obvious symptoms. She put me on a short course of antibiotics which I took in the days between Christmas and New Year. They seemed to clear something up as I definitely felt more clear headed afterwards. Within about a week though I caught what felt like a heavy cold (not Covid as I tested several times) which has left me with a residual cough, pain under or in the right ribs and some stomach disturbance (I’ve been prone to gastritis in the past, had gallstone pancreatitis before my gall bladder was removed and have a hiatus hernia and a patch of gastric erosion so infections often set off digestive issues).I went to my GP last week who, having listened to my chest, said I had indications of an infection in my lower right lung , but no signs of pleurisy or pneumonia, and said that, as I was on steroids that may be making it difficult for me to clear the gunge. She put me on a 5 day course of Clarithromycin which seems to have had limited effect. I’m not coughing so much but the dull twinging in the rib area is still there and occasionally feels like a sharp spasm. Not sure whether I’ve damaged a rib or muscles with the coughing or whether this is something else more related to my digestive issues or a liver problem. Oxygen stats, temps, blood pressure have all been fine throughout but I’m finding it all quite wearing and not a little anxiety provoking as my late husband’s kidney cancer was only diagnosed after it had gone to his back and ribs. Common sense however tells me that as this discomfort in the ribs was coterminous with the virus or whatever it was and is in the same place where the GP was picking up things with the stethoscope, that it’s not anything too major and I may just need to be patient and ride it out.

I am going back to the GP tomorrow as she said to return if I didn’t feel better after completing the course. I’m not sure what to ask for now as repeated courses of antibiotics won’t be doing my digestive system much good and meantime I’m not sure what to do about my steroids as she advised not putting my dose up as it might cause further problems and mask the real issue. Should I ask for an x-ray or ultrasound to try to get a better picture of what’s going on and fresh set of blood tests to see where my markers are at? Has anyone else had this sort of issue with the bugs currently going round and how long has it taken them to throw it off? My rheumatologist seems to have thrown me back on my GP and hasn’t offered another appt until May, by which time she is likely to have retired or moved on, so I don’t feel overly confident in seeking advice from her. She had said at our last appt that I should start tapering again and go to 9mg but though I am keen to get off steroids as soon as I can, I don’t think it wise to reduce just yet , but am I putting myself in a Catch 22 where the steroids are actually making it harder for me to recover? Grateful for any perspectives.

[DorsetLady PMRGCAuk volunteer]

Unfortunately the steroids do weaken your immune system -they need to help your illness-but it does have the knock on effect if you being more susceptible to infections that normally your body could cope with.

An X-ray might a good idea - if only yo put your mind at rest.

Definitely no tapering for time being - you’ve been through a lot lately so don’t add more pressure.

And although you’d probably prefer not to have another round of ABX that might be required -and even though you haven’t tested positive for Covid -doesn’t mean it isn’t that -so plenty of TLC as well as time required.

Best wishes 🌸

[SnazzyD]

When I tested positive in Sept my husband didn’t but was also ill. his went to his chest and mine was very coughy and I had very acidic stomach and mild upset rest of the gut. When it happened again in Dec same old cough that went on for 6 weeks. My lower rib muscles were not happy. I would get a sharp twinge and could put my finger on it exactly.

I think an x-ray is a reasonable request if antibiotics haven’t helped fully.

When I was on Pred my fluid intake had to be spot on in order to avoid UTI’s. Pred also irritated my bladder which could feel the same but never tested positive to anything.

[PMRpro Ambassador]

I think an x-ray would be a good idea - and if the GP would have used a short course of pred normally, I wonder why she didn't now? The combo of abx and pred helps clear things out quicker and reduces the risk of a lung infection. I wonder if you might have developed a bit of pleurisy?

But I suspect the original infect WAS Covid - lots of people aren't testing positive when others with identical symptoms are.

And NO tapering!! The markers won't mean much, they are very non-specific and could be raised from PMR or from a chest infection - they can send the CRP into the stratosphere!!!

[Sungolfer]

hi just replying to your comment on Urine Infection - having never had one before ever - since starting Pred in October had a very resistant one in November that took 3 courses of antibiotics- and then another one about 2 weeks ago which did disappear after a 3 day course of nitrofurentoin. But interestingly as SnazzyD says I always seem to have a slightly irritated bladder - particularly in the evening when I have an alcoholic drink!!

Good luck to you Menno1525 and aren’t we lucky having so many knowledgeable folk to turn to with our queries!