Low grade fever for 10 weeks

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,SLE, 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....

[Bhupinder Kaur, MD]

Hello,

Yours ymptoms are suggestive of PUO or FUO(Fever of unknown origin).It is defined as a temperature higher than 38.3°C (100.9°F) that lasts for more than three weeks with no obvious source despite appropriate investigation.It is mostly caused due to infections,malignancies and autoimmune diseases.The important possibilities are tuberculosis(ruled out in your case),leukemia,cancer,subacute bacterial endocarditis,parasitic and fungal infections,hodgkin’s or non hodgkin’s disease.

I feel that a physician’s consultation and host of lab investigations like blood tests(ANA antibodies),chest x-ray,tumor markers,bone marrow biopsy etc are required to confirm a diagnosis.Pls get it done.Till that time take acetaminophen(Tylenol) when fever is there.

Hope it helps.Take care and pls do keep me posted on how you are doing.

[imarshad]

Thanks for looking into my post....
I have already done ANA, chest X ray , Biopsy, and bone marrow culture etc.
ANA was negative
Chest X Ray shows enlarged lymph nodes.
Biopsy on the swollen leg showed benign cells
Bone Marrow culture result is still awaited....

[Dr. Kokil Mathur]

Hi

Thanks for such a detailed post. I read your post carefully and I realize your Montoux Test is negative. However this does not rule out tuberculosis as many drugs, BCG Vaccination that we take during infancy etc interfere with the test result. Negative test is in a way meaningless. Please refer: http://www.somalidoc.com/smf/qaybta-su'aalaha/montoux-test/  The link also suggests some tests that can be done to confirm the diagnosis of TB.

You also mention some swelling in your leg. I think you should rule out Filariasis, which is again a mosquito borne disease. Maybe it is an early stage of that. Please check it out at http://en.wikipedia.org/wiki/Filariasis

Meanwhile take plenty of fluids as hydration of the body is important. Consult your doctor with these possibilities. If you need more help, please feel free to contact. I’ll be happy to answer your queries.

[imarshad]

Thanks for the input.... I will discuss the doctor about Filariasis... and will keep updating the forum about any progress...

[Dr. Kokil Mathur]

Hi

Thanks for the post.

When you go to your doctor please discuss the other confirmatory tests for TB too. Please refer: http://www.somalidoc.com/smf/qaybta-su'aalaha/montoux-test/  

Please keep us posted. All the best!

[imarshad]

The doctor gave me a test dose of ATT for two weeks.
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 extra pulmonary TB which was not diagnosed....

[Dr. Kokil Mathur]

I am glad your problem sorted out. All the best! Take care and get well soon!

[garu88]

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