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What causes chronic fever, joint pain and mild dizziness?

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Posted on Thu, 9 Oct 2014
Question: I am surprised my case has been closed, it was earlier reviewed by DR, PRAVEN. Reason I have to reinitiate. Hi team, its nice to be part of this health forum, my name is XXXX and my complaint goes thus;
For over 11 months till date, I have been having persistent fever feeling as part of my everyday life and been coping with it with no remedy or diagnosis to determine the exact cause or origin. The symptoms are described below:
Permanent fever feeling, discomfort in the head far from pain and headache, internal hotness in the body running through my chest down to my stomach and legs, joint pains, mild dizziness, general weakness, lower back pain, shoulder pain and lots more. it is really strange because I live with all of this symptoms at part of my everyday life. in this sense, I am unable achieve a normal day life as I had to resign from my place of work.
I have been to several clinics and hospitals with different blood investigations and all negative. in recent time all my doctors seems clueless and lost of ideas to the cause of my complaints.
doctor
Answered by Dr. Praveen (21 hours later)
Brief Answer:
PCV doubtful. Suspect lymph node enlargement

Detailed Answer:
Hi dear.Thanks for sharing a detailed history along with the reports and the opinions from your doctors.

I have thoroughly gone through the clinical history.

According to me-

a.All the reports are unremarkable. Clinical chemistry report/electrolyte report, Blood and urine report(except for high normal cholesterol level), serology, Cardiovascular measurements, Hematology report are within the normal limits.

I were to recommend dietary/lifestyle modification, stress relaxation techniques, yoga, exercise as the first step to reduce the cholesterol levels. Would repeat lipid profile after 3 months and start on mild dose of hypolipidemic drug if not controlled on lifestyle modifications.

b.High CPK is non specific and indicates underlying chronic inflammation.

c.Since I do not totally agree with diagnosis of PCV, I were to investigate further for enlargement of spleen/liver (organomegaly) by doing a ultrasound abdominal scan. If the test is negative I were to do a bone marrow biopsy which is the diagnostic test.

d.More importantly, I were to do contrast CT of abdomen and thorax to rule out any underlying lymph nodal/organ enlarged which might cause these non specific symptoms.

Since the symptoms of nonspecific a battery of tests have been done to identify the cause. My deep regrets for the effort that have been taken and money that has been spent to get all of these relevant investigations and I hope our medical fraternity shall definitely diagnose the underlying condition.

Hope this answers your query.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Praveen (18 days later)
Thank you for your response Dr. XXXXXXX am sure you didn't get my follow up questions before closing my case, although I am yet to go for the suggested test recommended for me. My questions below: a, as regards the high cholesterol noticed -1, what side effect would that have on my health, and if so what kind of dietary would you suggest for me been an XXXXXXX 2, are you saying if monitored and test repeated and result is still high, drug would be recommended to reduce the cholesterol level. b, Chronic inflammation sounds really scary and life threatening but I don't pray it is in my own case. if it is, what will be the measures of treatment to correct such. c, what are your reasons not to agree with the diagnosis of PCV ( polycythaemia). d, your response seems direct, are you concluding that all the symptoms mentioned could be as a result of nodal/ organ enlargement. - What is organ enlargement if I may ask ?
doctor
Answered by Dr. Praveen (6 hours later)
Brief Answer:
Suggest lifestyle/dietary change for ldl

Detailed Answer:
Hi dear.Hope you are doing well.Thanks for writing me back.

High high cholesterol(LDL and TG) left untreated will deposit/clog in the blood vessels that supply vital organs(brain, heart etc) and impair the blood supply resulting in stroke or heart attack.This ideally takes months to years.Since your LDL is high normal and I were to recommend lifestyle and dietary modification (which remains same irrespective of ethnic origin).Nothing to panic!

Eat heart-healthy foods- choose leaner cuts of meat, low-fat dairy and monounsaturated fats — found in olive, peanut and canola oils.Use egg substitutes and skim milk instead.Eliminate trans fats - Trans fat can be found in fried foods and many commercial baked products, such as cookies, crackers and snack cakes.Use food rich in omega-3 fatty acids include walnuts, almonds and ground flaxseeds.Stock up on fruits and vegetables.Select whole grains. Inspite having taken these measures if you have a high LDL's then I were to start on low dose(Atorvastatin 10mg) which is safe and the current standard of care.

Chronic inflammation can be due to any underlying cause and is associated with conditions of varied etiology. CPK is a non-specific marker.You may not panic since this not life threatening as it sounds to be.Once the underlying cause is diagnosed I am sure CPK levels shall revert to normal.

As discussed above, since your PCV and other cell counts are within the normal limits(in the hematology test report) I were to evaluate further for organomegaly and do a bone marrow biopsy to confirm PCV.

Spleen, liver and lymph nodes are the organs which play predominant role in the immune system and are the first line of defense.When our body has to handle abnormal blood cells(as in polycythemia vera/leukemia/lymphoma) these organs increase in their size- organomegaly(increase in size of spleen/liver), lyphadenopathy - increase in size of lymph node.Since most investigations are normal and your symptoms may be a manifestation of abnormal immune function, I were to rule out the above findings by doing relevant investigations as discussed in my previous answer before I evaluate further.

Hope this answers your query.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Praveen (5 hours later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Praveen (3 hours later)
Brief Answer:
Guess they are old reports

Detailed Answer:
Hi.I have gone through all the attachments but unable to find any new reports.Guess they are the old ones.Kindly attach if you have new reports.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Praveen (21 hours later)
Your response is highly appreciated Dr. XXXXXXX My response for further clarification;

For the lifestyle/dietary change, how long am i suppose to monitor same before repeating the investigation to confirm if their improvement or not.

As regards the PCV, you are suggesting a bone marrow biopsy to confirm PCV. This has been done before now but not sure if it is same investigation you are referring to and also not sure if I attached the report in my previous response. Report of previous bone marrow investigation will be attached for your review and advice.


Lastly, what is the possibility of been invited over to any of your locations, or affiliated hospitals/clinics for physical review and further investigations. I really would not mind if that can b possible because before now I was making arrangement to go to the UK for a long stay to get to the root of my illness before discovering this forum online.

The new attachment named 9, 10. please review
doctor
Answered by Dr. Praveen (14 hours later)
Brief Answer:
Attachments missing

Detailed Answer:
Hello dear.Thanks for writing me back.

Lifestyle changes shall keep you fit and healthy apart from keep your cholesterol, sugars and pressures are at bay(if they are high).I were to ideally repeat the lipid profile after 2-3 months after adopt hearty lifestyle.If not controlled would recommend mid dose of statin(Atorvastatin 10mg once daily which has to be continued for the rest of the life, dose of which has to be titrated according to lipid levels)

Unfortunately I donot see the reports named 9 and 10 in the list.You may try deleting few previous attachments and upload bone marrow reports and the rest.

Yeah, I really appreciate the idea and the interest to come down to my place for a medical opinion.I am put up in XXXXXXX city, Karnataka(State) in XXXXXXX I assure that I can definitely refer you to one of the good hospitals here for further evaluation.

Hope I have satisfactorily answered your query.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen (4 hours later)
I am surprised you still cant see the bone marrow report attached. I don't know how else to achieve that. Can an email be provided so I can forward same via email. thank you
doctor
Answered by Dr. Praveen (7 hours later)
Brief Answer:
Soo sorry

Detailed Answer:
I am extremely sorry about that.
My email id is YYYY@YYYY .

Best,
Dr.Praveen
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Praveen

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Practicing since :2008

Answered : 1055 Questions

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What causes chronic fever, joint pain and mild dizziness?

Brief Answer: PCV doubtful. Suspect lymph node enlargement Detailed Answer: Hi dear.Thanks for sharing a detailed history along with the reports and the opinions from your doctors. I have thoroughly gone through the clinical history. According to me- a.All the reports are unremarkable. Clinical chemistry report/electrolyte report, Blood and urine report(except for high normal cholesterol level), serology, Cardiovascular measurements, Hematology report are within the normal limits. I were to recommend dietary/lifestyle modification, stress relaxation techniques, yoga, exercise as the first step to reduce the cholesterol levels. Would repeat lipid profile after 3 months and start on mild dose of hypolipidemic drug if not controlled on lifestyle modifications. b.High CPK is non specific and indicates underlying chronic inflammation. c.Since I do not totally agree with diagnosis of PCV, I were to investigate further for enlargement of spleen/liver (organomegaly) by doing a ultrasound abdominal scan. If the test is negative I were to do a bone marrow biopsy which is the diagnostic test. d.More importantly, I were to do contrast CT of abdomen and thorax to rule out any underlying lymph nodal/organ enlarged which might cause these non specific symptoms. Since the symptoms of nonspecific a battery of tests have been done to identify the cause. My deep regrets for the effort that have been taken and money that has been spent to get all of these relevant investigations and I hope our medical fraternity shall definitely diagnose the underlying condition. Hope this answers your query.