5 weeks of fever out of the last 10 and continuing....

[garyr]

AVR, CCF 4/00 Cosgrove;

In June first A-fib; in September after vigorous exercise two days before, left and right Quadriceps were sore, and fever onset
lasting three weeks. October got some strength back, and worked vigorously no home projects requiring lifting, squeezing, sustained hard work for hours at a time, then on November 6 fever recurred and has been ongoing, reaching as high as 103, and taking 2 Tylenol X-strength to suppress.  

Now taking two tylenol at 11 pm. for last three days which is when fever spikes.

Blood cultures have been run 4 times and rheumatologist is running a fifth set now. My GP has thrown in the towel on what is causing this recurrent fever.

A TEE was completed a week ago and is shows thickening of this relatively new valve, PFO, previously undiagnosed, and elevated gradients, peak 57 peak and 43 mean.

I thought the blood cultures would eliminate vegetation as a source of fever, and the TEE would confirm it but the Rheumatologist said there is no conclusive test yet done that would completely eliminate bacteria on the valve as a source of fever, which now has me thoroughly confused. He also wants to do a Temporal Artery biopsy to test for giant cell arteritis which I am very reluctant to do.

I have called the CCF cardiologist and await her repsonse as to myu next moves to determine the cause of this recurring fever. The only other symptoms are left upper calf pain, right femur and/or quadricep pain, intermittent left elbow stabbing pains, left forearm pain a day after the TEE. Any ideas at all as to next step?

[garyr]

Sorry, could not respond sooner as I have been hospitalized for third A-Fib event, for two days, and discharged yesterday with a regimen of 25 mg Atenolol 2X a day, Prednisone 20MG 2X a day, along with aspirin, Oscal D, Actonel, multivitamin, and xanax.

I have an appointment at CCF Cardiology on 12/6/02 for a second opinion on what might be wrong with me.

As of now, a unilateral temporal artery biopsy was completed and came back negative, but is still inconclusive.

Prednisone seems to have helped alleviate the fever.

But just beginning the atenolol is causing some weakness and definitely an even lower resting rate in 44 range sitting, and possibly even lower asleep. I awoke three times last night as if my heart rate was even lower while asleep. My normal resting rate is 54.

There is some agreement forming among the doctors that 'inflammation' of some kind may be causing all my difficulties including the A-fib events, (possibly even the increased AV gradients??) but no further testing is planned, just a 'wait and see' what happens on the drugs.

This is very puzzling and worrisome...

[CCF-M.D.-RCJ]

Garyr,

Thanks for your question.

You need to return to the CCF before this gets out of control.  

The advantage of big centers is not that any one person or doctor is clearly superior to an outside doctor; the advantage is that the team is superior.  The team includes the person doing the TEE, the microbiology lab, the interpreter of the TEE, your doctor, etc.

I am very concerned about the aortic valve; especially in the setting of the recently increased gradients and newly diagnosed PFO.  Bring the TEE tape with you.

Hope that helps.