Unraveling Mysterious Immune Reactions: Antibiotic Allergies or Autoimmune Disorders?

Is the strange illness experienced personally due to a drug allergy or an autoimmune disorder?

Hello, doctor.
I have encountered a strange immune reaction while taking medication and would like to ask for your advice.
Earlier this year, I was on long-term antibiotics due to a prostate infection, but I experienced tendonitis as an adverse reaction to the primary antibiotic.
There was only one antibiotic that I could tolerate, which I took for six weeks.
During this time, I developed purpura due to vasculitis in my lower limbs, but it was not painful and went untreated.
Afterward, I stopped the medication for seven days due to severe diarrhea, but the infection worsened.
The doctor prescribed the same antibiotic again along with probiotics (Bifidobacterium longum), which resolved the diarrhea issue, but after about two weeks of continuous use, I began to experience joint pain in multiple areas.
The pain worsened, and the purpura also intensified.
I consulted an immunologist and was prescribed steroids to suppress the symptoms.
(Before the joint pain symptoms appeared, I had blood tests related to vasculitis at the immunology department, and aside from elevated IgA levels, there were no significant abnormalities, so no treatment was initiated.) After a month, since the antibiotic treatment was stagnant with no significant improvement, I sought care at another hospital.
During this time, I stopped taking antibiotics, and the joint pain gradually improved, eventually resolving completely after seven days without the need for any anti-inflammatory or pain relief medications, including steroids.
(At this point, I began to suspect that the joint pain was caused by an allergy to the antibiotics.)
Due to various reasons, I had taken the suspected antibiotic along with another antibiotic (Teicoplanin) for three days without experiencing severe joint pain.
Later, I discussed with my doctor the possibility of switching to sulfonamide antibiotics, but I found the side effects of sulfonamides intolerable (sore throat, difficulty breathing, nausea, fatigue).
Before my next appointment, I decided to switch back to the suspected antibiotic instead of sulfonamide, and then a series of strange allergic reactions occurred: I took the medication at 9:00 PM, and within 30 minutes, I experienced noticeable swelling in multiple joints, with one muscle in my right hand and one in my left foot swelling (with significant tenderness).
After sleeping for eight hours, I woke up with stiff and painful joints.
Throughout the day, I continued to experience swelling in various joints, with the locations changing.
After taking probiotics at 7:00 PM, I felt even more joint pain within 30 minutes, and I developed a rash and urticaria.
I could not take the suspected medication again, so I switched to sulfonamide antibiotics.
Interestingly, after taking the other antibiotic, the persistent joint swelling that had lasted all day began to alleviate within 30 minutes.
(This was not a psychological effect! The swelling and pain were very noticeable and truly improved.)
Doctor, have you encountered such a strange case before? Taking two types of antibiotics simultaneously (the suspected allergic antibiotic and another broad-spectrum antibiotic) did not provoke a significant immune response, yet during the period of joint pain, taking another broad-spectrum antibiotic actually provided relief from this autoimmune-like condition.
What could be the reason for this? Additionally, I had taken the suspected antibiotic for over six weeks without any issues, but now I realize that the joint pain only started after I had been taking probiotics for a while, and I tested the probiotics yesterday, which worsened the allergic reaction.
Do you think it is more likely that the probiotics activated the immune system, or that changes in gut balance caused this phenomenon? I am also puzzled as to why taking other antibiotics immediately alleviated the symptoms; wouldn't the dead bacteria also cause sensitization? (Today, I took sulfonamide antibiotics along with a packet of probiotics, and my skin improved somewhat, but my joints are fine!) Since this relates to future medication choices, I am concerned that the doctors in the clinic may not have time to listen in detail, so I am asking for your assistance here.

Teng Tong Qiu Jiu, 30~39 year old female. Ask Date: 2021/05/15

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
I suspect that you may have Reiter's syndrome, also known as reactive arthritis, and I recommend that you consult a rheumatologist at a major hospital.
There are several reasons for my suspicion related to this condition, including chronic prostatitis, a history of diarrhea, elevated IgA levels, skin rashes, and recent episodes of recurrent arthritis.
These may not be related to the antibiotics or probiotics you are using; a slight addition of immunomodulatory medication might be sufficient.
You can discuss this with the rheumatologist, and if you are concerned that the doctor may not fully listen to your symptoms during the consultation, it may be helpful to organize your symptoms in this manner to show the doctor.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is concerned about you.

Reply Date: 2021/05/15

More Info

Your situation presents a complex interplay between antibiotic use, immune reactions, and potential autoimmune responses. It’s not uncommon for patients to experience unusual symptoms while on antibiotics, especially if there is a history of autoimmune disorders or sensitivities.
From your description, it seems that you have experienced a series of symptoms including tendonitis, purpura (skin bleeding), and joint pain, which could suggest an underlying autoimmune process or a hypersensitivity reaction to the antibiotics. The fact that you have had a history of prostatitis and were on long-term antibiotics may have contributed to an imbalance in your gut microbiome, potentially leading to dysbiosis. This imbalance can sometimes trigger immune responses that result in joint pain or other systemic symptoms.

The relationship between antibiotics and joint pain can be multifaceted. Some antibiotics can cause direct side effects like tendonitis, particularly fluoroquinolones, which are known for this adverse effect. Additionally, antibiotics can alter the gut flora, which plays a crucial role in immune function. When the gut microbiome is disrupted, it can lead to increased intestinal permeability, often referred to as "leaky gut," which may allow for the translocation of antigens into the bloodstream, potentially triggering autoimmune-like symptoms.

Regarding your experience with probiotics, while they are generally considered beneficial for gut health, they can sometimes provoke immune responses in sensitive individuals. If you noticed a worsening of symptoms after starting probiotics, it could be that the specific strains you were taking were not well-tolerated by your system, or they may have interacted with your immune response in a way that exacerbated your symptoms.

The fact that you experienced relief from joint pain after switching to another antibiotic suggests that the initial antibiotic may have been contributing to your symptoms, either through a direct allergic reaction or by exacerbating an underlying condition. It's also possible that the new antibiotic had a different effect on your gut microbiome, leading to a more favorable immune response.

In terms of your concerns about the immune system, it’s important to consider that autoimmune conditions can sometimes present with fluctuating symptoms that may not always correlate directly with medication use. The immune system is complex, and various factors, including stress, diet, and infections, can influence its behavior.
Given the complexity of your case, it would be advisable to consult with a rheumatologist or an immunologist who can perform a thorough evaluation, including blood tests and possibly imaging studies, to better understand the underlying causes of your symptoms. They may also consider conducting skin tests or other allergy assessments to determine if you have a true antibiotic allergy.

In summary, your symptoms could be attributed to a combination of antibiotic side effects, potential allergic reactions, and the influence of gut microbiome changes. It’s crucial to work closely with a healthcare provider who can help navigate these issues and tailor a treatment plan that considers both your antibiotic needs and your immune health.

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