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Fever, weight loss, fatigue, night sweats (why?)
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Fever, weight loss, fatigue, night sweats (why?)

Thank you in advance for your attention to my very long list of tests and questions.

Woman, 29 yrs old, no children.

About 3 months ago noticed fever (every day, about 37.3C), weight loss (at least 4 kilos in a couple of months); then occasional night sweats (not every night, but at least a couple of times a week); weakness, fatigue (especially huge in recent weeks; last weekend actually did not get out of bed – had no energy to); loss of appetite – i.e. general feeling of being unwell.

Diagnostic tests done so far:

- clinical blood test with blood cell count (done 2.5 months and a couple of weeks ago): all indicators within normal range, except for slightly increased eosinophils (doctor said, it must probably be allergy; I actually do have a hamster to whom I may be a bit allergic);
- X-ray of lungs (2 months ago): normal;
- abdominal ultrasound (2.5 months and 1 week ago): all normal;
- haematologist (2 months ago): looked at these tests (blood test, X-ray of lungs and ultrasound), checked my lymph nodes and said that she saw nothing haematological there;

- thyroid hormones: normal;

- esophagogastroduodenoscopy (1.5 months ago): all normal, with the exception of “too much bile in the stomach”;
- colonoscopy with biopsy (to rule out microscopic colitis) (1.5 months ago): all normal, with the exception of a small haemorrhoid; bowel movements for some time already have been either normal or a bit like diarrhoea (unformed large amount of mash; with proportion of normal to abnormal bowel movements about 50/50), but as this has already been for some time – maybe half a year, maybe a year – I have never paid huge attention to it before..;

- gynaecologist (2 months ago): transvaginal ultrasound and PAP smear test: normal;

- otorhinolaryngologist: all normal;

- infectologist (2 weeks ago): noticed icteric sclerae and did blood tests for toxoplasmosis, hepatitis, HIV, cytomegalovirus, Epstein-Barr: all normal; checked lymph nodes: in her opinion, they may be slightly enlarged, but she said that it may be because I’m rather slim, and if I weighted some 7 kilos more, she wouldn’t have felt them (??)

- liver blood tests about a month ago (ALT, AST, total and indirect bilirubin – normal; direct bilirubin – increased (4.7; norm – under 3.4); alkaline phosphatase decreased) and a week ago (ALT, AST – normal; total bilirubin – increased (22, norm – under 21), indirect bilirubin – increased (15.1, norm – under 17.7), direct bilirubin – increased (6.9, norm – under 3.4); alkaline phosphatase decreased);

- with view of icteric sclerae and increased bilirubins saw a gastroenterologist (a week ago), who ordered abdominal ultrasound (normal), and told that it could probably be Gilbert's syndrome (although I have never had such symptoms as icteric eyes before and no one in my family has this syndrome), not jaundice (as, she said, such an increase in bilirubins is not very high (??) and no obstructions in organs seem to be seen on the ultrasound). But together she said that even if it is Gilbert`s syndrome in no way it does explain the fever and weight loss;

- CT of organs of the abdominal cavity couple of days ago: all normal.

What would you advice in such a situation?
(except for a “full body MRI scan” as my GP was joking. Of course, no one will send me for full body MRI scan as it is awfully expensive for public medicine to sent people to do it, and me myself do not have such huge money to do it in a private diagnostic centre).
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4 Comments
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351246_tn?1379685732

Hi
Welcome to the MedHelp forum!
Mild icterus, fever, normal liver function all point towards a liver abscess. However with CT normal, it is possible that it is deep seated or below the diaphragm and was missed. Malaria, hemolytic fevers such as Dengue and hemolytic anemia (probably ruled out by the hematologist) can also be a cause. Talk to your doctor and take a course of anti malarial and see. Hope this helps. Do let me know if there is any thing else and keep me posted. Take care!

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Avatar_f_tn
Thank you.

However, I live in Lithuania, which is quite a northern country, and never travelled farther than to neighbouring countries (also more northern than central or south European), which, as far as I understand, makes such "exotic" (for North) diseases as malaria or Dengue fever rather unlikely..
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Avatar_f_tn
New blood test returned with worse results:
WBC (10e9/l) - 9.9 (norm 4.0-9.0)
NEU (%) - 74.2 (norm 50-72)
LYM (%) - 18.23 (19-37)
NEU (10e9/l) 7.29 (2.0-6.93)
HGB (g/l) - 154.10 (120-150)
HCT (l/l) - 0.461 (0.36-0.42)

And, in general, I feel much worse: have no strength, fatigue, eyes still mildly yellow, still night sweats…

What could this mean and which doctor should I address with them? My dr says smth like "oh, it`s not such a dramatic change" and does nothing. But just a month ago ALL the blood test results were normal - and now this?!
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351246_tn?1379685732
Hi
Actually all the blood tests are normal as they are not too out of range. You should probably consult an endocrine specialist and rule out other causes of extreme fatigue like diabetes, hypothyroidism, low calcium, low Vit D etc.
Hope this helps. Take care!
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