Lower Left Stomach Pain w/Fevers months now.

[Linda0419]

I am writing about my usually healthy 43 yr. sister. April 2005 she suddenly had extreme shooting pain right side lower abdomen with diarrhea and 102 Temp. Went to hospital. They said diverticulitus (the one w/o the inflamation (inflammation))she was sent home 7 days antibiotics. 1 week later still pain and fevers back. Next week colonoscopy. Fine. OBGYN-fine- only small cyst on left side nothing to do with this. Next week lower abdomen CT scan w and w/o contrast. Fine. Next blood and stool samples. That showed C/DYS (not sure what that means) 10 days again heavy antibiotics. 7 days later fever started again. Back to hospital. 103 temp w/severe right side pain. Intravenous antibiotics. Dr's found massive Kidney infection (Pyelonefritis) Appendix looked fine but they operated and took anyway just in case. Dr. looked around in there all fine. Dr.said removed appendix looked fine. Home 7 days antibiotics. It is now 3 weeks later, no fevers thank goodness but severe pain still on right lower abdomen. I forgot gallbladder checked and looked fine also. It has been four months now with constant fevers, (except for the last 3 weeks) although 4 days after last hospital stay she ran a low grade fever even on the antibiotics. Her fevers usually spike and night and leave during the day. Dr.'s say they can not find anything wrong. She is having pain which she describes as shooting sometimes throbbing right where her appendix used to be. She is feeling depressed because nothing can be found. She says she feels bad all the time and you can hear it in her voice. She does not get sick from anything she eats and diarrhea comes and goes. I found your website and hope you can maybe steer us in a direction to go next. My sister is not a whimp like me. She is strong and never complains. But you can now see the pain in her face. One other thing to mention is that 2 weeks before the pain started she was in Santo Domingo. We thought maybe she caught a virus there but this has not panned out that way. Dr. told her wait six weeks because of appendix removed and she should feel better. I feel that is ridiculous, it is not a different pain it is the same as before. This is the same Dr. whom told her to keep waiting since April. Then she wound up with 103 temp. in the hospital. Please Help. Thank You, a worried Sister.

[Kevin Pho, MD]

This sounds like what is known as fever of unknown origin.  Clearly, there have been many GI tests and procedures undertaken.  

Here are some considerations.  The first would be various cultures - such as blood and urine - to evaluate for infection.  Imaging studies, like a CT scan of abdomen or pelvis, can be helpful in diagnosing abscesses that may not be immediately apparent.  

Regarding further evaluation of the RUQ pain, it seems that GI causes have been considered.  A transvaginal ultrasound can be considered to evaluate for GYN causes.  

More specific tests like a tagged white-cell scan can be done to search for infections.  

You may want to consider a referral to an infectious disease specialist for further evaluation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[Linda0419]

I AM SORRY TITLE SHOULD HAVE READ.   LOWER "RIGHT" STOMACH PAIN W/FEVERS MONTHS NOW.

[Linda0419]

I HOPE YOU SEE THIS BEFORE READING MY ARTICLE.  IT IS THE RIGHT SIDE NOT THE LEFT. DARN HOW CONFUSING FOR YOU.  I CAN'T BELIEVE I DID THIS. SORRY.

[sarikate]

Has your sister had stool studies done for ova and parasites?  She should have blood tests (CBC, CMP) and stool studies (O&P, fecal occult blood, fecal leukocytes, stool culture) done to check for the possibility of a parasitic infection.  With the fevers and diarrhea occurring so soon after traveling, this has to be a major consideration for the origin!  Infections like giardia or amoebiasis can cause severe pain and fevers like you are describing.

[sarikate]

It sounds like she had C. diff, an infection triggered by use of antibiotics that can be cleared up with different antibiotics (bizarre, I know).  That alone can cause major diarrheal problems.  But unless they do a stool culture, which is not routinely done, and O&Ps, they can't rule out parasites she may have picked up in Santo Domingo.  Also, post-surgery, even "minor" surgery like an appendectomy, can be significant and she really does need to give that a little more time to resolve.  The fact that her fevers have disappeared is a good sign.

[Linda0419]

THANK YOU FOR YOUR WONDERFUL ADVICE. I KNOW SHE HER STOOL WAS TESTED MULTIPLE TIMES IN THE HOSPITAL. HER HUSBAND WANTED IT TESTED FOR BACTERIA SHE COULD HAVE PICKED UP FROM SANTO DOMINGO. IT ALL TESTED NEGATIVE. BUT I WILL BE SURE TO MAKE SURE OF THE TWO YOU LISTED ESPECIALLY THE LAST ONE. THANK YOU AGAIN.

[sarikate]

I think Dr. K is right on with the idea to see an infectious disease specialist.  Hopefully you are near a big city where you might have a selection of specialists!  Good luck with solving this mystery.

[Linda0419]

While she was in the hospital for the week she had an Infectous disease Dr. That is the Dr. that took many, many, blood, urine and stool samples. All bacterial and infection were ruled out. Also since April of 2005 she has been to lab. 3 times for same thing. No bacteria or infectous disease were detected. She has has a ct scan also. Thank you again anyway. This is very baffling.

[lizziecee]

Hi - when I lived in southern Spain some 12 yrs ago I had dreadful diarrhea, high temperature, with foul smelling stools and a greenish discharge from the vagina. As I have Crohn's my doctors there thought it was a fistula from the rectum to the vagina. Comprehensive testing at one of the best hospitals in London England failed to find the cause. I even had a hysterectomy. I eventually saw an elderly physician (not a gastro nor a gyn)and I told him about an elderly dog that had been abandoned outside our villa, that I was feeding. That year a lot of dogs where I lived had to be put to sleep for Spanish Fly disease (leishmaniosis) - don't ask me why I told him this, but I was at my wits' end after a year of flying back and forth to England. He sent a swab to the London Hospital for Tropical diseases and it turned out I had contracted leishmaniasis (for some reason the spelling is different in animals and humans) and I was prescribed the correct antibiotic and the problem cleared up.Sorry but I can't remember the name of the antibiotic they gave me.

It is perhaps clutching at straws for your sister, and very rare, but not unknown in sub tropical countries,  for a human to get leishmaniasis, but because I have a compromised immune system (Crohn's) that is why they thought I got infected. I do hope your sister gets a proper diagnosis, and appropriate treatment soon.
Liz.

[Duchess47]

I have had these same symptoms and been to many docs havng many tests.  The last doc suggested seeing infectious disease specialist.  I was wondering about the fact that I went to Hawaii last year and could I have picked up something while there?  Could it last a year undetected?

[Linda0419]

My sister is not better as of this date. She is sick of Dr.s and tests. Dutchess, I understand from other research that it could last over a year. Hope you feel better soon and Lizzie I am glad you are feeling better. Good Luck. I am sincerley hope you all feel better real soon.

[Empreinte]

Hi Linda ~
I've been keeping up on what your Sister has been going
through and Geez, I am so sorry that she has something going
on here that is not resolving itself or at least easying up for her a bit.  With that thought, if this were me (and it was twice) or my Family Member and as long as this has been going on, plus the fact that she isn't doing much better - I would can every Doc you have or have seen and start all over again.  You need someone who has the ability to obtain a much quicker diagnosis than this.  I've been through what your Sister has - not the symptoms - but serious health problems and either I was lucky enough to find someone who could diagnose on the spot or (most times) not lucky enough and the situation just dragged on and on and on.  Twice, it nearly cost me my life and one of them was for a diagnosis of Crohn's Disease, which I most certainly have.  I live in a very well populated City and had every Doctor in this City walking in and out of my room for 6 weeks of hospitalization and not one of them could diagnose this - AND that was after several Colonoscopies and every G.I. testing known to man.  What it took was this - My attending Doc's came into my room and said that my last test results looked even worse than the day before - something to do with T cells, as well.  I had every blood and fecal test, etc.  I asked them both if I was going to die as I was so sick that I was down to 88 pounds (I was 5'8'' and weighed usually no more than 130/135) and could not keep food or water - liquid down at all.  I got the stall job on my question and I made it clear that I was a grown adult and just answer the damn question.  They both said it sure looked that way and there was nothing more that anyone could do for me.  I immediately said, with what energy I had left - GET ME OUT OF THIS CITY - I refuse to die.  I was flown out to another City at a University Hospital and immediately Diagnosed.  They saved my life and were completely p.o.'d and astonished that a proper diagnosis and a 6 week hospital stay plus being ill for 2 years prior to be hospitalized that not one of these Doctor's and there were many in many different Specialties could not figure this out.  It really nearly cost me my life waiting around for these dip shits to figure out where their brains were - I could tell you now where they were, that's for sure.  I had to stay 3 weeks at this U. Hospital to get intense treatment as I was a total mess by that time.  When I returned home I told these Doc's here what I had and they had to ask me how to spell it for them for God's sake.  Some had never heard of it and they were G.I. Doc's! We did find this hard to believe and when relayed back to the U. Hospital they concurred.
Covering themselves up is what they all were doing - All of them.
Point being:  Don't wait too much longer - Get her out of town and I do not blame her one bit for being sick and tired of this run kind of run around - especially, when one is so very ill.  My Husband literally had to carry me into the Hospital here - I just couldn't walk.  I was a light load by that time, though!
Do whatever you have to do.  In retrospect my Husband and I were
WAYYYY toooooooo trusting and we were too nice to everyone.  We should have raised the roof - in other words - if you can't figure my sister out then bring someone in who can or just fire the whole lot of them and do it while she is in the hospital. The hospital is responsible to call in and so are you newer Doctors for her.  My best to you all and especially to your Sister.
I know that this is a very hard, difficult, and scary time for all of you but much more so for your Sister.  God Bless you - I will say prayers for all of you - sincerely.

Been there~
Empreinte

[Linda0419]

Thank you very much for your heartfelt letter. I am very happy to hear you were diagnosed properly and doing well. I would be to every Dr. I could be to if I were my sister. She is different than I am. Just spoke with her last night and she still has the pain but no fevers since her appendix out. I told her nothing is there to hurt you but you are hurting(alot yesterday) I can't believe this anymore. She seems to be just living with the pain for now. Me I would be hitting the Dr. curcuit. Last night she said she would probably be going back to a OBGYN in a week or so. At least that is something because I feel she has given up hope on being treated properly. She gets very depressed and defensive when I say go to more Doctors. But I will keep pressing her to go. Thank you again. Best Wishes. Linda