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Fever for 9weeks, no diagnosis or answers. Any ideas?
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Fever for 9weeks, no diagnosis or answers. Any ideas?

I'm 22 year old female. No surgeries or prior diagnoses other than born with innocent heart murmur and mono about 4 years ago. The heart murmur "grew up" at my 6 month old appointment and no one has heard it in 21 years.


April 7th, 2013- First noticed fever, headache, and body aches.
      9Th- Seen at Urgent Care . (BP: 140/98 HR: 104 Temp: 101)
              Influenza A & B-Negative, Heart Murmur discovered
              Received celestone shot and discharged with Viral Syndrome.
       15th- Contacted Urgent Care with no relief from symptoms
               Prescribed Medrol Dose Pack with strict instructions of 2 pills/day for 5 days.
      23rd- Seen at Urgent Care with same symptoms. (BP: 150/108 HR: 123 Temp: 100.8)
               ALT-89 AST-50 WBC-11.2
               HIV-1 &2- negative;  Acute Hep Panel- negative; West Nile- negative;
               Monospot-negative;  Blood cultures- no growth
               Prescribed Levaquin 750mg/10 days and discharged with Febrile Illness & Acute Sinusitis
      30th- Seen at Urgent Care with same symptoms. (BP: 151/103 HR: 130 Temp: 101.2)
               ALT- 120 AST-90
               Was told: Elevated lymphocytes and SED RATE
               Was told: Cytomegalo Virus- negative; Epstein Barr Virus- makers indicative of past infection;
                Discussed referral to Infectious Disease MD and discharged with Febrile Illness
May 2nd-Seen at Family Doctor with same symptoms  (BP: 139/92 HR: 114 Temp: 99.8)
              ALT-248 AST-172  SED RATE-24 Lupus panel- negative; Lyme- negative; RPR- nonreative;
              CEA- normal;  TSH- normal; Uric Acid- normal; DBIL- normal; ANA- negative
       20th- Referred liver specialist.      (BP: 130/80 Temp: 99.8)
                Was told: ANA-negative; Mitochondrial antibodies- negative; Smooth muscle antibodies-negative
                Liver enzymes- “Almost normal”  
                Discharged with referral for abdomen ultrasound
       24th- Ultrasound of Abdomen:
                Bilateral small pleural effusions
      28th –CT of Abdomen ordered by Family MD:
                Mild splenomegaly and 2cm mass on adnexal probably cystic ovarian in nature.
June 4, 2013- Current Symptoms include: Fever, body aches, fatigue, weakness, mild dyspnea, UQ abdominal                  
                        pain, nasal congestion , & decreased appetite.  BP: 157/90 HR: 98 Temp: 100.1

Any ideas? Please help! I'm still running fever and feel miserable everyday.
Thanks..
5 Comments Post a Comment
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Avatar_dr_f_tn
Hi,
How are you? I'm sorry to hear about your fever and symptoms for the last 9 weeks. Fever of unknown origin (FUO) in adults is defined as a temperature higher than 38.3 C  that lasts for more than three weeks. There is no improvement  after appropriate investigations were done. The possible underlying cause may be attributed to infections, malignancies, autoimmune conditions, and other unrelated pathologies. Further evaluation may need to be done to determine the underlying cause. History, physical examination, and standard laboratory testing remain the basis of the initial evaluation. Referral to an infectious disease specialist may also be beneficial. Take care and do keep us posted.
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Avatar_f_tn
Thanks for the reply. I'm still feeling about the same. Some days are definitely worse than others, but still running fever everyday. My fever stays between 99-100.5 F throughout the day. I can't find any patterns, sometimes it's higher in the morning, sometimes at night. I recently noticed a petechiae-like rash on my arms. Small pin point size red dots that fade and quickly return to normal when I press on them. I know that I've had two of these dots for months, but I just noticed I now have about 20 between my two arms. Don't know if this could be related, I guess I'll let my doctor decide. Also, I've started coughing now too. I haven't had a cough since this all started 2 months ago. I guess it could be related to the pleural effusion found during the ultrasound? Or maybe just congestion from my sinuses?

I do, now, have an appointment with a internal Medicine MD on Monday. I didn't have a primary physician, because of insurance issues. Now that it's all been resolved, I wanted to have a primary who can follow me.
I also, have a appointment with an infectious disease on the 24th. Still a few weeks away, so hopefully my new internal med/primary with be able to figure something out.

Thanks again!
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Avatar_f_tn
Also, you mentioned autoimmune diseases. I have had a negative ANA twice, is it possible/likely to still have an autoimmune disease like lupus after having a negative ANA?
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Avatar_f_tn
Update:

Infectious disease Dr. diagnosed me with active cmv and ebv. She says it may have been too early to detect the antibodies when other doctors previously tested me.
Recently I started having episodes of coughing and wheezing, primary dr prescribed steroids (medrol dose pack), antibiotic, and albuterol inhaler for bronchitis.
I have now been off the steroids and antibiotic for 3 days and although the coughing has seized, the muscle aches from ebv/cmv are back, full force.
The odd thing was that I have already had ebv, and it has showed up on blood tests multiple times. The last test however showed no sign of previous ebv infection, only a current. Could it have been reactivated?
I'm still working full time and trying to go about my life normally, but the fever, body aches, and fatigue is horrible. It really effects my quality of life, no doubt. I'm working on 5 months of being sick! Ugh!!
Should I be worried about my immune system? Why can't my body fight this off, I should be in my prime at 22 years old.
Any suggestions on immune boosting vitamins, herbs, diet suggestions? I'm really open to trying anything:) Specialized doctors in prolonged ebv/cmv infections?
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Avatar_dr_f_tn
Hi,
Thanks for your updates. It is good that you were able to see your infectious specialist. Cytomegalovirus (CMV),  one of the herpesviruses, is a common infection that is usually harmless.  The virus stays dormant (most of the time, but it can reactivate  and cause illness including fever, sore throat and fatigue. Reactivation of a previous CMV infection is a more common problem for persons with weakened immune systems  such as those with cancer or HIV, bone marrow or organ  transplant and those taking immunosuppresants.  EBV, on the other hand, also establishes a lifelong dormant infection in some cells of the body's immune system. However, when such an illness lasts more than 6 months, it is frequently called chronic EBV infection. Boosting your immune system include intake of vitamin c and eating healthy. Regular follow-up with your infectious disease specialist is recommended. Take care always.
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