I presented in the ER 5 weeks ago with upper right and left abdominal pain and fever of 101. I had been treated previously on and off for 3 years for "suspected" diverticulitis and after a course of Cipro, I would be back to normal. This night in the ER they ran labs and did an abd ct scan. The scan showed multiple gall stones and also a thickening of the colon "suggestive" per the report of diverticulitis. The labs were basically normal, including WBC. I do, however; have iron deficiency anemia after doing the labs and a follow up anemia panel. All other tests in the anemia panel were normal. I was placed on cipro and the pain and fever subsided. After going off the medication, the pain (left sided) and fever returned. This has been the case for over a month! I am scheduled to see a GI specialist and have a colonoscopy and egd on Oct 30. The baffling thing is after 3 weeks of cipro, I was switched to flagyl when the pain and fever returned. Now after a week of flagyl, the pain is gone (first time in 5 weeks) but I still am running a low grade temp of 99.0 - 99.6. Temp returns to normal at night. I am just so frustrated and baffled. Why will this not resolve? Why is my pain totally gone but a low grade temp remaining? Could gall stones aggrevate and lead to diverticulitis? Help!!!!!!!!!!!!
I’ll try and address your concerns to the best of my capability.
Fever, left lower abdominal pain and increased WBC is the triad of diverticulitis. CT scan with contrast, done after drinking contrast, shows colon wall thickening due to diverticulae or out-pouchings. Thickened colon wall on normal CT/ultrasound can also be due to chronic colitis. Colitis can also present with lower left abdominal pain and fever.
Since you have gall stones, you could be having infection/inflammation of gall bladder. This can cause upper left abdominal pain and fever. This could be the reason for fever persisting in your case. Gall stones need to be surgically removed and if the gall bladder is chronically inflamed, it will need to be removed as well. Normally inflamed gall bladder reduces digestion of fat, causes gas in abdomen and a generalized abdominal pain.
Chronic gut and gall bladder inflammation can also cause low grade fever. Drinking plenty of water may help reduce the day time fever.
Since you responded to flagyl, in my opinion, you could be suffering from infective or parasitic colitis. To treat colitis completely, you have to find the cause first. It may be an inflammatory bowel disease (Crohn’s, ulcerative colitis, IBS etc), or ischemic colitis, infectious colitis, autoimmune colitis, microscopic colitis or allergic colitis. The treatment thus includes antibiotics, corticosteroids, immune modulators, surgery, diet modification etc depending on the type of colitis. For diet modification, you can identify the triggers by logging in your food and symptoms and correlating them.
When you meet the GI specialist, you can discuss all these points and ask regarding tests that will help diagnose your condition. Management and presentation of colitis and diverticulitis in the initial stage is somewhat same. Therefore all the differential diagnosis addressed in the previous para should be ruled out.
I sincerely hope you will find this information useful in your journey towards better health.
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