Discussions By Condition: I cannot get a diagnosis.

Fever since Mar, 08

Posted In: I cannot get a diagnosis. 20 Replies
  • Posted By: true.karan
  • September 12, 2008
  • 04:43 PM

Hi

This fever started in March, 08. In April, skin hives also started every other day (I thought these were because of some antibiotics that I took in March). I am pointing the symptoms I face:
Fever always starts during the evenings
I usually have mild fever (upto 37.3 C / 99 F)
Temp becomes normal on its own in 2 - 3 hours (even if I don't take medicine)
Hives happen on arms, elbows, hips, back. Skin becomes very itchy that time
During fever, I feel weakness (esp. in legs)
During daytime, my body temp. is usually lower than normal
My could not eat much, feels like puking many a times
I have NOT lost weight
I do NOT have coughI had all these test done:
Chest X ray
Ultrasound
TB
Barium meal X ray
Thyroid
Other blood testsNothing has been reported as yet.

Please help, what it can be ??
Thanks !!

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20 Replies:

  • It could be autoimmune, as most autoimmune conditions are characterized by fever and rash, have you seen a rheumatologist?
    qwertyuiop123 453 Replies
    • September 12, 2008
    • 04:48 PM
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  • I have not consulted him yet. I'll talk to my doctor tomorrow if this could be a possibility.
    true.karan 8 Replies
    • September 12, 2008
    • 05:50 PM
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  • If you have had a fever constant on and off for 6 months and the hives you are having a allergic reaction to something in either your enviroment or food or clothing,and yes a allergy to a antibiotic will cause hives which do itch like crazy you can try benedryll allergy that will stop the hives and itch,but I really think your having a allergic reaction to something,the hard part is finding out what,so think back to march what did you change "food,soap otc meds," and you can eliminate 1 thing every couple days till you find the allergen.
    simidrm 36 Replies
    • September 13, 2008
    • 05:39 AM
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  • Thanks for all your answers.The Dr has told me these 5 possibilities:TBTyphoidComplicated MalariaAutoimmuneReasons unknown (I forget the term used)He said, Autoimmune DO not seem to be a good possibility because in that case this medicine CETIRIZINE do not help, but that gives me a relief.Still not sure about the diagnosis.
    true.karan 8 Replies
    • September 15, 2008
    • 05:19 AM
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  • have you been exposed to tb? do you live in an area where typhoid or malaria are present? did you travel out of the country? did you travel to an area where typhoid or malaria or present? how high are your fevers?
    fewd4thought 126 Replies
    • September 15, 2008
    • 07:34 AM
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  • I traveled to a hill station in Feb. Fever started in March. Yeah, it can be an infection.Fever stays usually 99 degree F. Go up to 100 sometimes.
    true.karan 8 Replies
    • September 15, 2008
    • 07:38 AM
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  • Temperature will fluctuate during the day with cortisol levels. Don't worry about your body temperature being 'low', this isn't a problem for people, (unless you are say... stranded on Mt Everest without your parka) and you would not gauge your high temperatures relative to this low temperature. Medically speaking, a person has a fever when their temperature is measured to be 38 degrees celsius or 100.4 degrees F.
    fewd4thought 126 Replies
    • September 15, 2008
    • 07:44 AM
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  • A hill station where? Like Simla? Whatever is endemic in the region that you travelled to will be the culprit. Tell everyone whether you took any prophylaxis, etc. I don't really understand where your confusion is coming from.
    fewd4thought 126 Replies
    • September 15, 2008
    • 07:51 AM
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  • Yeah, I traveled to Shimla only. But, we did not take any prophylaxis as you mentioned.I stayed perfect for a month since we return.Though, I try to ignore the low temp & temp. upto 99. But, temp over that (that also occurs sometimes) can't be ignored.My hands usually stay warmer than people around.Plus, the skin allergy.I am really thankful to your replies, let me know if you still have any doubts regarding my condition.
    true.karan 8 Replies
    • September 15, 2008
    • 08:16 AM
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  • Um, wow, I must be psychic, because I have had to guess more about your medical history than you have been willing to provide?!I'm not certain I was clear before about fevers, so let me be more direct. A temperature of 99F, or even 100F is not a fever. A temperature must rise to 100.4F, or 38C to be medically considered a fever. That is the strict definition of a fever. So...basically you can ignore your temperatures until they become a fever. I'm not saying that you don't have risk factors for an infectious process. Clearly your doctor thinks so, that is why he has generated a differential diagnosis for you straight out of a tropical medicine textbook. It looks like you are getting a pretty thorough work up and I for one will definitely post if I can think of anything else that will explain your symptoms.
    fewd4thought 126 Replies
    • September 15, 2008
    • 08:41 AM
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  • Now, Dr. asked me to get these 4 tests done. I am writing the findings against each of these:ESR = 21Quatiferon TB Gold = Positive (though Mantaux was negative 3 months back)CRP = 23.86 mg/LANA = RatioHave we reached some stage of diagnosis?Plus, I have a minor pain in Right Iliac Fossa (that is only felt if pressed) & some skin lesions on my back.He suggested me to go for a Biopsy of Skin Lesion / Lower abdomen CT scan / Opinion from other Doctors before arriving at a conclusion.Is it TB or should I further try to diagnose?Regards
    true.karan 8 Replies
    • September 18, 2008
    • 09:25 AM
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  • ANA ratio was also negative. I forgot to mention in post above.
    true.karan 8 Replies
    • September 18, 2008
    • 03:32 PM
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  • Okay, the clinical term used for unknown origin is ideopathic. If the lesions on your torso have appeared since you first noticed any other symptoms, then depending upon their characteristic features a biopsy will likely help bring the diagnosis forth. I'd be interested to know more about the lesions, their size, color, whether they appear as wheals above the surface of the surrounding skin and whether they are producing parasthesia of any type at the location of the lesions themselves, whether they feel rough to the touch and present you with any pain. Systemic TB can be a possibility, but realize that a postive TB test can occur if the patient has been exposed to any one of the various types of mycobacterium and overall symptoms are typically more florid than what you describe with regard to active TB. I too am of the opinion that your recorded temperatures do not necessarily constitute fever. The normal diurnal rhthym associated with glucocorticosteroids is responsible for the variation in body temperature from morning to evening. The presence of positive lymph nodes would also be important, either inguinal or supraclavicular, relative to pain in the area of the iliac fossa and if the pain has been persistent then I would concur with obtaining an abdominal CT. We typically and most readily associate pain at the right iliac fossa with appendicitis, but your symptoms are far too prolonged and would have fully developed in the case of appendicitis by now. This also does not appear to present itself in the manner of an autoimmune disorder. I'd be interested to know how your tests turn out and if you care to, please post the results for discussion. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • September 18, 2008
    • 11:25 PM
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  • Today, i consulted few more Dr. They say it can be appendicitis.In any case, I am going through a CT scan tomorrow.
    true.karan 8 Replies
    • September 19, 2008
    • 00:53 PM
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  • The ct scan is a good idea, but i don't think appendicitis would cause a fever for that long, but maybe the ct will show something
    qwertyuiop123 453 Replies
    • September 19, 2008
    • 03:30 PM
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  • I have an idea for a low grade fever that comes at cetain times.But Have you had any exposure to sheep goats, or cattle. And exposure to these animals abroad as this disease is almost eridicated in the USA and the UK.If yes then there is a possiblilty of Brucella infection.
    chrismia 159 Replies
    • September 19, 2008
    • 04:52 PM
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  • What about Gulf War Syndrome? Some people are getting tested for mycoplasma (check out Clongen Labs---15% of the veterans they checked were positive). There are some websites under Gulf War Syndrome and mycoplasma; a Dr. Nicholson has created a research laboratory.Have you been checked for malaria?All of fewd4thougt's comments make good sense. Good luck.
    marionstar 228 Replies
    • September 19, 2008
    • 11:14 PM
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  • There is a new post by tmommy cat called "Get Tested For These First." Check it out on the "new posts." She is very knowlegable about these rara conditions, including mycoplasma, ureaplasma, Lyme, etc.One website she lists is http://www.whale.to/m/scott7.html#IV...DISEASE_AGENTS_If you answer on her message, you will be notified when there is activity on that thread. Marionstar
    marionstar 228 Replies
    • September 19, 2008
    • 11:40 PM
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  • My lower abdomen CT scan results are as under:Urinary bladder appears normal. The bladder wall is normal.No free fluid is seen.The prostate is normal in size & attenuation.Now, something which is not normal:There is evidence of asymmetric circumferential mural thickening involving IC junction, caecum & adjacent part of ascending colon. And, there is a mild circumferential thickening of appendix. IC junction is pulled up.Mild asymmetric mural thickening is also seen involving infero-lateral wall at the junction of 2nd & 3rd part of duodenum, contiguos with thickening of ascending colon.Multiple enlarged lymphnodes are seen in right iliac fossa & mesentery. Several of them show central hypodensity & peripheral rim enhancement suggestive of central necrosis.Result: Findings are suggestive of abdominal TB.---Now, few questions coming in my mind:I think, I should start with TB course (that may last for 6 months). Am i correct?What has to be done for the appendix thing I mentioned above?
    true.karan 8 Replies
    • September 21, 2008
    • 03:29 PM
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  • How great you are finally getting a diagnosis. Your doctor is to be credited, as are you for continuing to pursue this. I would certainly see what your doctor says about medications, but usually for TB you have to treat for atl least months if not a year. And this is with triple medications. But, the wooner you treat, the sooner you will get back to your health. Good luck; keep us posted.
    marionstar 228 Replies
    • September 22, 2008
    • 05:17 PM
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