Rib pain in a 23-year-old woman with severe asthma

breathing. The pain radiated vertically up her back, to the flank and thoracic cage. She reported associated hip pain and right side pain with deep inspiration. She described the pain as sharp, especially over the right lower lumbar vertebra and right buttock. She denied coughing, wheezing, fever, dysuria, trauma, joint pain, chills, and fatigue. Her medications included flunisolide MDI (250 g), 5 puffs four times a day; ipratroprium MDI, 2 puffs four times a day; prednisone, 10 mg daily; nedocromil MDI, 2 puffs four times a day; omeprazole, 40 mg daily; albuterol, 2.5 mg by nebulization four times a day; lorazepam, acetaminophen, trimethoprim-sulfamethoxizole, ranitidine, 150 mg twice daily; beclomethasone nasal spray twice daily; loratadine, 10 mg daily; and cisapride, 10 mg four times a day. She denied taking oral contraceptives, herbal supplements, and complementary medicine. Spirometry was normal with FVC 110%, FEV1 98%, FEV1/FVC ratio 89%, peak flow 109%, and FEF25–75 80% of predicted flow.