Having headache, hot flashes and nausea with fever. What could be the underlying cause?
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hi there...i have been sick for almost a month now. it started with a headache and nausea with a fever. after 2 weeks, i went to the dr(2 weeks ago) and he didn't know what to do. he put me on a different diabetes med as metformin can upset the stomach and checked for a bladder infection (didn't have one). i continued to be nauseous on and off for 1.5 weeks and then this last wed started getting awful headaches again with nausea and low grade fever around 100.2. the fever goes away when i go to sleep but starts again late morning. i have hot flashes (am 51 and think i am starting menopause-take 3 mo. bc pill so i get my period once a month-didn't get it this last week after stopping the pill). i can't take much more of this. any suggestions of what to do? i decided to stay home from work monday if not better and go back to dr. just afraid he won't know what to do...help?? thank you
Posted Mon, 2 Dec 2013 in Headache and Migraines
Answered by Dr. Nsah Bernard 6 hours later
Brief Answer: Do evaluation for fever of unknown origin Detailed Answer: Hello, Thanks for posting on XXXXXXX I am so sorry for the troubles you have encountered. Personally, I doubt if your doctor does not know what to do but he might rather be faced with a fever of unknown origin (FUO). FUOs are caused by infections (30-40%), neoplasms (20-30%), collagen vascular diseases (10-20%), and numerous miscellaneous diseases (15-20%). The literature also reveals that between 5 and 15% of FUO cases defy diagnosis, despite exhaustive studies (Reference: WWW.WWWW.WW . The following conditions are sources of FUO: - Abscesses: Usually is accompanied by a localized pain (where ever the abscess is located in your body) - Tuberculosis: often presents with high grade fever and night sweats especially if pulmonary. TB of other organs may present with just fever. - Urinary tract infections: Urine test may show normal, but the infection might still be present - Endocarditis: Can be missed if a cardiac exams was not carefully performed by your doctor to detect heart murmurs - Hepatobiliary infections: which require evaluation of the liver and gallbladder - Osteomyelitis - Chlamydia - Systemic bacterial illnesses or sepsis: requires blood culture. Also other systemic viral and parasitic diseases need to be ruled out especially if you are found in an endemic zone e.g test for malaria which I doubt you have that given you are located in the USA. Others such as enteric fever, enterocolitis etc - HIV/Acquired immunodeficiency syndrome (AIDS) - Herpes viruses - Fungal infections - Parasitic infections - Lymphomas: Presence of lymph nodes significantly increase chances of this condition - Leukemias - Solid tumors: Pain usually is present - Malignant histiocytosis - Collagen vascular and autoimmune diseases: There are good number and your doctor should be able to consider this then go ahead to running diagnostic tests. - Endocrine disorders - Factitious fever - Rheumatic diseases - Premenopausal syndrome: can present with pseudofever (false fever) which might trick some practitioners if not put into consideration. - Pelvic inflammatory diseases (PID): often accompanied by pelvic pain. In your situations, I will start by evaluating first the most likely (I will be guided by the results of patient's physical exams and other findings after conducting general laboratory tests. Note that, FUOs can be problematic in determining the cause, but with a little bit of patience from your health care providers and from yourself, the cause should able to be sorted out. Tests to rule out the most likely possibilities include laboratory work-ups and Ct scan. If all the tests run turn out clear, then I suggest you to be referred to a gynecologist (for a start), then to an internist who can better assimilate all symptoms, signs, laboratory and imagery findings then reach to a definite conclusion. Hope this helps and wish you the best. Dr. Nsah