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Have fever. Temperature back to normal after some time. Having frequent fever. Normal after few days. Have extremely itchy forearms. Cause?

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Pulmonologist
Practicing since : 2003
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At night I awaken & find that I have a fever. I get up & in a while again take my temp. & it is back to normal. This is repeated over & over with fever returning when I recline. Then when I get up it returns to normal. This happened about a 1-1/2 months ago & after 5 days in hosp. no cause was found & I was back to normal. Now it started again 4 days ago.

I am also constantly troubled by extremely itchy forearms. Nothing seems to give me much relief. Ice packs seem to work best.
Posted Tue, 8 Oct 2013 in Lung Cancer
 
 
Answered by Dr. Gyanshankar Mishra 43 minutes later
Brief Answer:
Symptomatic treatment is required.

Detailed Answer:
Hi,
1. Considering that you were diagnosed with stage 4 vlung cancer and you have completed palliative chemotherapy regime, your current symptoms need symptomatic treatment.

2. Fever may sometimes present as paraneoplastic syndrome. An extensive search for the cause of fever is required, like presence of any secondary infections in the lungs. What is the fresh chest xray lpicture? If there is any evidence of secondary infection then a course of antibiotics in supervision with your doctor is required.

3. You may take an antihistaminic medication for itching in consultation with your doctor.

4. Also considering the fact that you are on an experimental anti cancer drug, there is a possibility that these symptoms could be drug related and you need to immediately report these the concerned physician who is looking after you.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Have fever. Temperature back to normal after some time. Having frequent fever. Normal after few days. Have extremely itchy forearms. Cause? 1 hour later
No, you have not answered my question. The last scan show the right lung (the left one was removed in 2012) as clear. My question was why do I have a fever while lying down & when I get up my temperature becomes normal?
 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Brief Answer:
Possibility of drug related effect.

Detailed Answer:
Hi,
Thanks for the follow up.

1. With the limited amount of info given i.e. you had stage 4 lung cancer, my previous post was made.

2. Now with the additional info that you have undergone left pneumonectomy in in 2012, let me inform herewith, that if it was indeed stage 4 lung cancer then stage 4 lung cancer is normally not operated since stage 4 definition itself states that the malignancy has distal metastasis. There are sometimes micro metastasis. A PET scan is normally done to look for malignant activity. If your whole body PET scan (nuclear isotope scan) was negative then that needs to be observed at regular intervals. It si good that the right lung is apparently free of any possible tumor spread.

3. A symptom of "Positional fever" is not known in medical literature. If it is indeed so, you need to measure your body temperature with a clinical thermometer in both standing and lying down position (fever is defined as temperature >99.7 degree farenhiet). So please confirm the symptom by a clinical thermometer.

4. The possibility of drug fever and itching due to the new drug cannot be ruled out and hence in absence of any other etiology, the experimental drug can be related to the symptoms of fever and itching (considering your other investigations including blood counts and ESR are normal.). This symptom needs to be reported to the concerned clinical physician. If the symptom has developed after initiation of the new drug , then the effect can be related to your new drug.

5. If the symptom was pre existing prior to the initiation of the new drug then other causes such as secondary infection needs to be ruled out and the focus needs to be searched in the body.

6. Considering your past history of pneumonectomy, and infection of the post pneumonectomy stump needs to be ruled out. In a pneumonectomy patient positional variation of chest symptoms due to decreased vital capacity is known but not postional variation of body temeperature. Also do let me inform herewith that body temperature does not change in seconds and it takes time for body temperature to rise or fall. A change of temperature associated with posture is too fast to actually happen. If such is indeed the case, a 2 D echo (to confirm that cardiac and pulmonary circulation )are normal may be done.

I hope I have answered your query. I will be glad to answer follow up queries if any.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Have fever. Temperature back to normal after some time. Having frequent fever. Normal after few days. Have extremely itchy forearms. Cause? 7 hours later
Don't know where you got the idea that the temp. change was instantaneous.
After a 30 minute trip to the emergency room the temp. was normal. In other instances there was always a generous waiting time, after getting up, before checking the temp.
 
 
Answered by Dr. Gyanshankar Mishra 12 minutes later
Brief Answer:
The fever seems to be drug fever.

Detailed Answer:
Hi,
Thanks for the follow up.


1. Investigations as mentioned in the previous posts need to be done and infection is the most common cause of fever and needs to be ruled out.


2. If the fever takes time to come and go , then its relation with posture seems to be incidental and it seems to decrease more on rest rather then in supine position. A non response to standard line of management and with investigations ruling out other causes, the fever is more likely due to the experimental drug GDC 0980. Please report it to the concerned physician incharge of the drug trial.

I hope I have answered your query. I will be glad to answer follow up queries if any.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Have fever. Temperature back to normal after some time. Having frequent fever. Normal after few days. Have extremely itchy forearms. Cause? 27 minutes later
Drugs? I think you are just doing the easy answer. The cardiac & pulmonary circulation theory makes more sense to me. The pneumonectomy necessitated cutting very close to the heart which resulted in a high heart rate. Wonder if scar tissue could be part of the problem.
 
 
Answered by Dr. Gyanshankar Mishra 27 minutes later
Brief Answer:
After "all causes" being ruled out.

Detailed Answer:
Hi,
Thanks for the follow up.

1. As said in the previous posts if "all other" causes are ruled out then drug fever needs to be considered and investigatigations have been mentioned in the previous posts.

2. Infections are by far the common causes of fever. I am enumerating the investigations that need to be done in case of a fever in a past operated case of lung cancer - chest xray pa view, cbc, esr, peripheral smear, 2D echo (to rule out pulmonary hypertension or micro embolism to be more specific) and lastly a detailed clinical examination including examination of your lymph nodes. Never to forget a whole body PET scan needs to be done during follow up to pick up any recurrence at the earliest.

3. Secondary infection of a pneumonectomy stump may be a cause but it needs to have cough with it.

4. The plane of pneumonectomy always goes from near the mediastinum or heart and the increase is heart rate (tachycardia) is transient and normalises gradually. Also the decrease in vital capacity leads to a transient increase in heart rate after pneumonectomy but the body adapts itself to it.

5. Your fever is of recent onset and needs to be investigated accordingly.

I hope I have answered your query. I will be glad to answer follow up queries if any.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by
 
Follow-up: Have fever. Temperature back to normal after some time. Having frequent fever. Normal after few days. Have extremely itchy forearms. Cause? 1 hour later
I also need to mention that the surgery was so close to the heart that a "patch" was applied.

You have not said whether a fever that comes & goes according to the position of the patient is normal or not.
 
 
Answered by Dr. Gyanshankar Mishra 7 hours later
Brief Answer:
Fever is not normal and requires evaluation.

Detailed Answer:
Hi,
Thanks for the follow up.

1. If the surgical plane of the pneumonectomy was close to the mediastinum and a "patch" was applied, then a 2d echo to look into the condition of the heart and vessels will help. I suppose your ct scan thorax does not show any adverse findings about the same (2012).

2. Fever of any type is not normal needs to be investigated. Rather then the positional variation, it seems to subside with rest. Do get the evaluation done as mentioned in the previous post.

3. If an infective etiology (which is the most common cause of fever) is not found then do remember that anti cancer agents are fairly kinown to cause drug fever.

4. Also I will mention it here that since you were a stage 4 lung cancer previously, hence a need for an experimental drug to confirm that if there was any micrometastasis that will be taken care of and also the medication will decrease the chances of relapse, but adverse effects like fever and itching are not uncommon and you should be aware about the same. Please go through the patient information brochure of the drug that they must have given you prior to the initiation of the drug and read in detail all the possible side effects.

I hope I have answered your query. I will be glad to answer follow up queries if any.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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