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Has fever, swelling in hands and legs with reddening of blood vessels. Done with tests. Findings?

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Practicing since : 2001
Answered : 12750 Questions
My Wife , Age 39 years.

She has fever almost daily / alternate day upto 9-101 degree Fahrenheit for 2-3 hours.
With fever, swellings in hand and legs, with redening of blood vessels seen.

Upon advice of physicial following tests were done
Haemoglobin :10.6
Total Leucocyte count :0000
Polymorphs :65%
Eosinophils :05%
Total Erythrocyte count : 3.9
Packed cell volume: 32.7%
Patelet count:1.98%
Peripheral Smear:Red Cells are predominantly normocytic.No haemoparasite seen.
C-Reative Protein: Positive
Rhematoid Factor : Negative
Blood Sugar Fasting :80.6%
Urine sugar : Nil.Blood Sugar Prandial: 122.8
Urine sugar : Nil
Anti Hepatitis C Virus Total : 0.36
Vit B12: 280pg/ml
25 OH Vitamin D :8.2 ng/ml
Anti streptolysin O:410IU/ml
Chest CA view: RT clove elevated / but MD has said it to be normal
CRP Serum 13.7 mg/L
TB Gold Gamma Interfer ION Plasma
Gamma Interferon , Antigen tube: 0.36 IU/ml
Gamma Interferon , Nil tube :0.07 IU/ml
Final result : Negative
The patient 50 mcg of Thyrox.
TSH Report on 24.12.2002: 44.65 Started taking 100 mcg Thyrox/ Eltroxin
TSH Report on 17.3.13:4.782 Dose was changed to 50 mcg

The consulting Physical has said that there is no problem. She has to exercise and take in more fibre in diet and reduce fats, carbohydrates and proteins.

But with such high ASO, ESR & WBC, is there no other problem.

Posted Tue, 2 Jul 2013 in Infections
Answered by Dr. Rakhi Tayal 1 hour later
Thanks for posting your query.
I have gone through all the details provided by you.
The raised ESR, ASO and WBC counts is suggestive of an infection in the body. This could be a persistent viral infection as all other parameters are normal.
Prolonged fever for more than 3 weeks without a specific usual cause is termed as pyrexia of unknown origin (PUO).
PUOs are caused by infections (30-40%), neoplasms (20-30%), collagen vascular diseases (10-20%), and numerous miscellaneous diseases (15-20%).
She can have a blood and urine culture test to detect any minor infections. Connective tissue disorders also need to be ruled out after consulting a rheumatologist.
I would suggest you to follow up with your treating doctor and take an opinion of a rheumatologist and endocrinmologist.

Till then have a good diet, specially protein XXXXXXX diet which helps a lot in speedy recovery. She should include more of pulses in her diet along with fresh fruits, milk, cheese, eggs etc. in her day to day diet.
Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Rakhi Tayal.
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