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Dr. Sohaib
Dr. Sohaib, Doctor
Category: Medical
Satisfied Customers: 5225
Experience:  MBBS, FCPS Experienced in all Medical Specialities
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My soon has been getting periodic fever every month for 2/3

Customer Question

My soon has been getting periodic fever every month for 2/3 days this last year . Exactly within a month he has 99C and then next daty 100/101 and then next day 99 and hes fine the fourth day. He has no other symptons except mild tonsilitis/and constipation and his fever needs Advil or Tylenol to keep his fever down.
We have done all blood tests and strep throat tests and yrine and stool tests and everything is normal exceptwhite blood cells count is less on his fever days.
To go deeper we have shown him to a PFP specialist Periodic Fever specialist who said that this is something we have to live itand it will go away on its own.
Is there anywhere or anyother doctor who an recheck him and see if he needs any furthurtests or diagnosis please send details
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Sohaib replied 4 years ago.

Hello and thank you for the question.
Answers given are for informational purposes only and are not meant to replace an exam by an in-person.

I am Dr. Sohaib, a practicing Internal Medicine Specialist and i will do my best to help you today.

You need to answer a few questions first which will help me assist you in a better way.

What kind of tests did he have?

Bone marrow examination?

CT scan of chest and abdomen?

Blood cultures?

Screened for tuberculosis?

Customer: replied 4 years ago.

Blood detailed tests and cultures have been done many times.

No bone marrow examination or screening for tuberculosis has been done.

Expert:  Dr. Sohaib replied 4 years ago.

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.

It was a pleasure assisting you and thank you very much for visiting us.

My goal is to provide you with Excellent Service - if satisfied with the response, Please do not forget to Rate my service.

If you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Kindest Regards.

Expert:  Dr. Sohaib replied 4 years ago.
Hello Naz.
I am here for a follow up.
Is there anything else i can help you with?
I will be glad to assist.