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What Causes Fever, Severe Headache, Nausea And Back Pain?

Posted on Tue, 8 Sep 2015

Question: I have been feeling ill (hangover feeling) off and on for the last 2.5 months. I have been tested for Lyme, RMSF, west Nile, and another tick-borne illness all of which have come up negative. The worst of my sickness was in mid-June where I ran a temperature of 99-100 at night time with sever head pain, slight nausea, and pretty strong back pain. When I would wake up in the morning the pain would be gone but I would still have the "hangover" feeling (slight nausea, extreme drowsiness and fatigue) by about 2pm in the afternoon the pain would start again and gradually get worse as the evening went on. I would go to sleep and start the whole thing over again. This lasted 2 weeks until I was prescribed antibiotics for 21 days while we waited for the Lyme and RMSF results. After about 5 days on the antibiotics I felt better and was back to normal. Once my antibiotics ran out it took about 2 weeks and then the same symptoms started to return. The only difference is that the pain is only mild in the head but a major "hangover" feeling. Last week I felt really good for 4 days and then did my evening jog and felt an unusual burning in my chest after. The next day which was Friday I felt totally fatigued and drowsy like I hadn't slept in days, although I got 10 hours of sleep the night before. I'm at a loss and don't know what to do. I'm a 35 year old male in excellent shape and eat healthy. Any help would be appreciated.

Answered by Dr. Tushar Kanti Biswas (5 hours later)

Brief Answer:
?Chronic Lyme Disease?Chronic fatigue syndrome (CFS)

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
It seems you have Chronic fatigue syndrome (CFS) preceded by non-specified illness from which you have apparently recovered ,in view of long-term fatigue and other symptoms.
Post–Lyme Syndrome (Chronic Lyme Disease-as you have been treated with a course of amoxycillin for 30 days with partial improvement) despite resolution of the objective manifestations of the infection with antibiotic therapy, ~10% of patients (although the reported percentages vary widely) continue to have subjective pain, neurocognitive manifestations, or fatigue
symptoms. These symptoms usually improve and resolve within
months but may last for years.The symptoms may be similar to or indistinguishable from chronic fatigue syndrome.
Relatively high percentages of CFS cases follow Q fever and Lyme disease.
What is the kind of test(serological) you have undergone for Lyme Disease?

Another thin possibility is infectious mononucleosis (IM).
While some patients have malaise and fatigue that persist for weeks or months after IM, persistent EBV infection however is not a cause of chronic fatigue syndrome.Chronic active EBV infection is very rare.

Antidepressant treatment may be helpful. Alertnativey psychostimulants such as modafinil, can help increase alertness and concentration and reduce excessive daytime sleepiness(extreme drowsiness etc).

Vitamin B12 injections are sometimes useful despite normal serum B12 and folate levels,to relieve non-specific pain.

Consult your doctor for review.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Tushar Kanti Biswas (12 hours later)

Thank you for the reply. I had antibodies test done for Lyme, Rocky Mountain Spotted Fever and West Nile Virus (2 times). All of which came up negative. Could I still have one of these even if they showed up negative? What do you suggest I discuss with my doctor?

XXXXX

Answered by Dr. Tushar Kanti Biswas (7 hours later)

Brief Answer:
Likley Chronic fatigue syndrome (CFS) & management

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Your symptomatology suggests CFS but it seems there is no definitively identified cause in your case.

Infection (usually a flulike illness or infectious mononucleosis) can be the trigger but antibodies test done for Lyme, Rocky Mountain Spotted Fever and West Nile Virus (2 times) came negative and hence ruled out.

Titers of antibody to EBV ,particularly IgG antibody to VCA (viral
capsid antigen ) can be done, though serology for viral or bacterial infections usually is not helpful.

There is some evidence that CFS patients have mild hypocortisolism, the degree of which is associated with a poorer response to cognitive behavioral therapy(CBT). Hence sreum cortisol at 8 AM & 8PM can be undertaken. This will eliminate possibility of hypoadrenalism causing undue fatigue etc.

Serum electrolytes particularly serum sodium level should also be done to exclude any chronic hyponatraemia.

The following laboratory screen usually suffices: complete blood count; erythrocyte sedimentation rate; C-reactive protein; serum creatinine, electrolytes (already mentioned), calcium,and iron; blood glucose; creatine kinase; liver function tests; thyroid stimulating hormone; anti-gliadin antibodies; and urinalysis ( essentially to exclude disorders causing fatigue).

I feel most of the tests must have been done already in your case by your doctor.

CBT and graded exercise therapy (GET) have been found to be the
only beneficial interventions in CFS.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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

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