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Fever With Severe Headache. Tests Related To Widal And Dengue Came Negative. What Does CT Scan Report Says?

Posted on Mon, 18 Nov 2013

Question: Hi ,
I am 22 yrs old , Female .For the past three months , am suffering from fever with severe head ache for every 2 weeks . It is ON and OFF periodically . I took all the tests related to Widal , dengue, Malarial Parasite .All shows Negative . And took normal blood test too.
My ESR(WESTERGREN METHOD) was 32 when i had fever . After temperature got reduced , took another ESR level test now . It is 42 now . I am wondering how it s keep on increasing . I took scan of my Brain and Chest as my physician suggested . Please find below for that CT Scan inference :
1)Mild asymmetry in size of lateral ventricles seen with subtle dilatation of left ventricle .
2)Minimal mucosal thickening of left maxillary antra .
3)No obvious demonstrable infarct or haemorrhage or SOL in brain parenchyma .
Screening of Chest :-
================
1)Minimal bronchial , prebronchial thickening and cuffing with air trapping seen .
2)At present no evidence of active pulmonary /mediastinal/pleural Tuberculosis seen .

Now doctor injected me the TB test injection and asked me to come after 72 hrs .
Please suggest me , what it may be ?!

Thanks in advance for ur answers. !

Answered by Dr. Irshad H Naqvi (1 hour later)

Brief Answer:
First Probable diagnosis could be tuberculosis.

Detailed Answer:
Hi,

Fever for 3 months,
High Increasing ESR.
CXR- Peribronchial thickening & cuffing

Based on the rests my Probable first diagnosis is tuberculosis. Therefore you need to be investigated further. If I were to be your treating doctor, I would the following tests:
- TB Gold Quantiferon Test .
- PCR test for blood and tissue of genital region, etc,

Now days genital tuberculosis is quite common. Whole abdomen ultrasound to rule out mesentric lymphadenopthy, any lesion at ceacal region or any organomegally can be helpful. Similarly perpheral blood smear is quite important.

The test which was last performed is Montoux test which is an indirect marker to TB. Let me know the results after 72 hours. It would also be better if you can upload chest X-ray film in th next query.

Have you lost weight??

Please feel free for further clarification.

Thanks

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Irshad H Naqvi (2 hours later)

Hi , Thanks for ur answer .
Please find attached for the X-ray of Chest .

No , I have not lose weight much . Reduced only one kg , now 60 kg from 59 kg .

Working as a software professional . So i thought headache might be the problem of eye . But have tested in vasan Eye Care .Everything was fine . If i sit in a system for a long time , getting severe headache . I will update the Montoux test Result after 72 hrs fr sure , InshaAllah . Am gonna get married . Please suggest me the medication as soon as possible . Thanks
Sorry , Now 59 kg from 60 kg . Was Typo error .

Answered by Dr. Irshad H Naqvi (6 hours later)

Brief Answer:
X XXXXXXX is non significant. ATT on trial basis.

Detailed Answer:
Hi

There is no pulmonary lesion in the Xray film except the bronchial cuffing. Can be labelled as inconclusive.
In adults, Montoux test is also many times inconclusive except it comes with exaggerated response.

In your case fever is most significant symptoms to point toward the diagnosis.
PCR (Polymerase Chain Reaction) or TB gold test may strongly support the diagnosis.

Many times if the diagnosis is not confirmed by these tests, then occasionally ATT (antitubercular treatment) is tried on trial basis. If the fever subsides with ATT on trial basis in week or two then it strongly support the diagnosis.

ATT should always be carried out with the strict supervision of Physician.

Best wishes for your marriage.

Further clarification is welcome.

Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Irshad H Naqvi (14 hours later)

Thanks for your reply !

Yeah , there is no sign (like bulg) out of Montoux test result now .Its been 48 hrs. A very small swelling in my hand with red in color have formed .

And i would like to know whether these symptoms determines the confirmation of TB problem and can i go with other tests and medication ?

Would CXR- Peribronchial thickening & cuffing be the TB problem specifically ? OR may be because of any allergic activities ?

Answered by Dr. Irshad H Naqvi (10 hours later)

Brief Answer:
Further test rquired as mentioned.

Detailed Answer:
Hi
Mx test to be read by the pathologist. But no weightage to be given in adults.

All the symptoms point towards the diseases. symptoms do not confirm the disease.

Many times disease can not be confirmed by tests. Only clinical observation and experience help in diagnosis of the disease.

CXRay peribronchial thickening and cuffing strongly point towards the said disease. These could be because of some other diseases like simple infection but less likely here and allergy in quite remote.

But the long term FEVER is a very very significant symptoms, can only be explained by the said disease.
Other causes of fever are already ruled out by the mentioned investigations.

I know to accept such problem intially is little difficult. Please have confidence on your doctor and let him take the experinced discision and allow him to treat you for your betterment.
If the diagnosis is accepted then treatment should be started immediately as this is a long course.

Hope the query is answerd.

Thanks

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Yogesh D