We are both doctors, my wife and I, we work at University of Medicine and Pharmacy from Tg.Mureş, Romania. Here is our medical problem.
Since october , last year, my wife has a fever which ranges between 38,1-38,6°C. The symptoms were initially, sugestive for a mild urinary low tract infection(disuria, polakyuria). She made treatment with Eficef(cefalosporine especially for UTI, for 7 days).The symptoms disapeared but fever remained since then.
So, as doctors we began to check every possibility to find the cause of this fever. Physical exam was unremarkable: no respiratory or cardiac signs, no adenopathies, liver or spleen were normal etc. We made several imaging investigations. Cerebral MRI showed no abnormalities. Thoracic and abdominal CT was also unremarkable (no pulmonary lesions, no mediastinal, hilar , retro- or intraperitoneal adenopathies , intra- and retroperitoneal organs were in normal limits- liver, spleen, stomach,small and large bowell, apendics, pancreas, kidneys, adrenals were unremarkable). Pelvic ultrasound showed bilateral unchanged ovarian endometriomas , followed since 2004, no visible free fluid or abscess. Thyroid ultrasound showed no nodules or other change of echogenity . cardiac ultrasound showed no changes suggestive for endocarditis.
We made three times laboratory tests, in november, december and january.
CBC showed only mild macrocytic anemia (3310000/mmc) and thrombocytopenia (113000/mmc), WBC were 5450/mmc with no changes of neutrophiles(59,3%) ,eosinophiles (0,9%), lymphocytes (31,7%) ,basophiles(0,4%) or monocytes (7,7%) . ESR – 16 mm at 1 hour .
Biochemical tests showed two times increased serum amylase (first time 116 U/L,second time 146 U/L- reference range 15-100 U/L), decreased alcaline phosphatase (first time 66U/L , second time 47 U/L- reference range 98-279U/L). Also, serum sodium was in three measurements decreased (first time 130 mmol/L, second time 131 mmol/L and last time 136 mmol/L – reference range 137-145 mmol/L).
Immunological tests -
-C-reactive protein was first time ↑36 mg/L and last time was lower than 5 mg/L,
-rheumatoid factor was negative,
-ASLO was negative,
-C3 was first time 137 mg/dL and 160 mg/dL second time- reference range 90-219 mg/dL,
-C4 was first time 17 mg/dL and ↑43 mg/dL second time – reference range 10-40 mg/dL,
-IgA was first time 75 mg/dL, second time↓ 67 mg/dL, third time↓ 50 mg/dL – reference range 70-400 md/dL,
-IgG was first time ↑1630 mg/dL, second time 1500 mg/dL, third time 930 mg/dL – reference range 700-1600 mg/dL,
-IgM was first time 145 mg/dL, second time 105 mg/dL, third time 110 mg/dL – reference range 40-240 mg/dL,
-Antigenes for B and C hepatitis were negative,
-Antibodies – AntiSmith antibodies- 4,3 U/mL ref range 0-10 U/mL
- Anti Jo 1 antibodies – 6,1 U/mL ref range 0-10 U/mL
- Anti cardiolipin IgG antibodies – 4,0 UI/mL ref range 0-10 U/mL
- Anti histone antibodies – 0,27 U/mL – ref range 0-1 U/mL
Last week we made also the gynecological yearly check and the pathologic result was an follicular exocervicitis , no atipical cells, filaments of Candida albicans and bacilli.
We ask for your help, if you could indicate us a diagnostic or to make other tests.
Thank you .
Dr. L. And I.Simu