Low grade fever for 10 weeks

[imarshad]

Hi all there,
                 I am 29 years male from Pakistan. I am having low grade fever (Usually between 100-101) in the evening for the last 10 weeks (daily without a single day off). During daytime I am normal. My symptoms are
1) Evening rise low grade fever.
2) Dry cough
3) Shortening of breath
4) Pain in small joints (fingers)
5) Fatigue and cramps when fever is above 100
Most of these symptoms sometimes are very prominent and sometimes disappear. But the fever is persistent from day 1.
I have undergone through quite a large number of diagnosis tests
1) Typhidot -ve
2) Malarial Parasites -ve
3) TB tests
a) Mycodot -ve
b) Mantoux -ve
c) PCR -ve
4) Brucella antibodies -ve
5) ANA/ANF -ve
6) LFT's show normal values.
7) Abdominal USG shows normal except mild fatty lever.
8) Many other tests like RA Factor, LDH, Blood count, Urine RE, Hepatitus (hepatitis) B,C , Blood sugar and many other were also performed and were in normal range. Bone Marrow culture and blood culture reports are awaited.
The abnormalities are in
1) Blood ESR which is 80-82 since two months
2) Chest X Ray which shows enlarged lymph nodes.

Now what diseases can I have ? The doctor suggested that I might have lymphoma, sarcoidosis, TB etc. but he is uncertain about what I have. He is suggesting I should start Tuberculosis course even though 3 different tests have come up negative???? Please suggest me something....

[Rowena Santos, MD]

Hi,

I'm sorry to hear what you've been through for the last ten weeks. Low-grade fever  typically defined as never exceeding 38.5 degrees Celsius (about 101 degrees Fahrenheit) and a non-specific finding. But this occurs in many diseases, ranging from infectious (viral infections or infective endocarditis) to autoimmune to malignant causes. What TB tests were done? A sputum test done 3x is the standard test for tuberculosis. A prophylactic TB medication may be recommended since dry cough, fever at night, and weight loss are main symptoms of this disease. However, exposure and positive findings on the chest xray, sputum tests must be present.

Take care and keep us posted.

[imarshad]

Thanks for looking into my post.... The three tests for Tuberculosis were

Mycodot (Blood)
Mantoux (Skin)
and
PCR (Microbacterium Tuberculosis) (Blood)
and all were negative....
and since I have dry cough I donot have sputum. Can sputum test still be done if we have dry cough?

also as I have mentioned I have not lost a single kg in the last 2 months....  

[Rowena Santos, MD]

Hi,

You may be asked to inhale a mist of salty steam in order to cough more deeply and produce sputum. If you still do not produce enough sputum, you might have a bronchoscopy. If the stain shows mycobacteria, the specimen may be placed in culture media, which encourages them to grow. It can help to drink a lot of fluids the night before the test. It makes the test more accurate if it's done first thing in the morning and done three times, often three days in a row.

Discuss this with your doctor and weigh the benefits and risks. Take care and keep us posted.

[imarshad]

I will keep you informed about updates and what the doctor says about the sputum test....

[okedocke]

Hope you find out whats going on I am having low grade fever too. however mine is now accompanied with slightly elevated lymph and slightly elevated ast alt liver enzyme. although for a while my tests came back fine. best of luck and God bless you I hope you find an answer. Okedocke

[imarshad]

Well I went to the doctor and he said that if I have tuberculosis then it is Extra pulmonary. He says that I most probably have a Lymph node TB. So a sputum test is insignificant.
He has started a 2 week trial ATT (Anti tuberculosis treatment) and said if I show some response then he will continue it.
I will comment after taking 2 week of medcine...

[imarshad]

Is your chest X-Ray/CT Scan normal?

[okedocke]

Yes, as far as I know the doctors are giveing me antibiotics. They don't seem real concerned but all other tests came back ok except tryglycerides they did not take an xray or ct scan. Hope all goes good for you, God bless ya Okedocke

[imarshad]

I have taken the two week course of anti tuberculosis treatment and within one week my fever disappeared. So the doc has ordered me to complete my treatment which will continue for 8 months. So most probably I had TB which was not diagnosed....

[imarshad]

I have taken the treatment for almost 6 weeks now and I feel very normal now. Only bad thing is taking 6 pills early in the morning and that too for 8 months...