Thank you very much for the useful information Naz.
With prolonged history of fever (intermittent or relapsing) along with cytopenias (low counts of any kind of blood cells) a bone marrow biopsy and examination should be done, especially if no other test is coming positive for a diagnosis to be achieved.
Moreover bone marrow should also be cultured, since in many cases of chronic infections the blood cultures are negative (also due to antibiotic use) and the offending bug is only diagnosed on bone marrow examination and culture.
Logically, there is some problem with the marrow that has been causing the white cell number to be reduced so that is why a bone marrow examination should be ordered and its self explanatory.
Then tuberculosis is another possibility which can give chronic intermittent fever.
Tuberculosis can affect any part such as lungs, intestines, liver or other glands in the abdomen and give its effects very slowly.
Cryptic Tuberculosis is a term used to describe tuberculosis where there are no other findings on the investigation but the patient continue to have fever. In such cases a therapeutic trial of anti-tuberculous drugs is given so there is no harm in getting him screened for tuberculosis.
Then finally, he needs CT scan of chest and abdomen as well. To look for any inflammatory or neoplastic lesion in the body. To identify any lymph nodes in the chest or abdomen (because at this stage we can not rule out the possibility of an occult hematological malignancy like lymphoma or leukaemia in evolution).
Bone marrow examination will help rule out any such possibility as well as evolving aplasia which can result in repeated clinical infections and recurrent fever.
And i should also mention to get his autoimmune profile done as many autoimmune disorders (which are in the process of evolution) can present initially only as fever and no other symptoms. So ANA, Anti-dsDNA and RA factor should also be done (and repeated if done already).
Your next step is to get a consultation with an Internist, and discuss all the details i have mentioned to chalk out further management plan.
I dont agree that there is any such condition (with recurrent fever) where it remains undiagnosed and untreated and one has to live with it.
There must be an underlying cause and we should continue with the diagnostic work up as well as management to exactly find out the cause and later on treat it specifically.
I would have been worried too if I were at your place, but let me reassure you that this is a treatable condition and carries a good prognosis with appropriate management.
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