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What causes persistent low grade fever, weight loss and excessive weakness?

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Posted on Thu, 5 May 2016
Question: My son 35 yrs suffering for low grade fever for almost two months with little weight loss & excessive weakness he has been very active & highly energetic. Initially he suffered two times high fever 3-4 days wih urine infection 14 hpf pus cells & urine culture showing moderate growth of margenella margenil. Blood CBC showing wbc 15.5, neutrophils 87% & lymphocytes 10%. But fever resolved in a week but returned 7 days later.
This time,i.e., 14 days after first fever, his urine routine & culture both were negative and wbc was with in range 5.6 except lymphocytes 53% & neutrophils 40%, monocyte 4%. Fever low grade 99-100F in morning & evening, sometime in day also wih mild stomach pain. Antibiotics Cifi & Zifi continuing.

Another 14 days( in all one month) later His ultrasound showed border line splenomegaly, Widal test & malaria test negative. Urine routine & culture negative. Repeat CBC showed rising lymphocytes & monocyte ( 58% & 8%) and falling neutrophils 32%. LFT showed substantially high SGOT 219 & SGPT 363, GGT 118, Serum alkali phosphate high 133, kidney panel was normal. HIV test negative

Fever now only on and off occasionally but stomach upset and tremendous weakness with continuing dry coughing occasionally.
Above antibiotics stopped 3 days back.

His chest X-ray clear but chest CT scan
( abdomen-pelvis CT clear) showed hypodense lymphnodes in right hilar region with heterogeneous growth , size 8 mm on short axis. Any other characteristic feature was absent in CT test/abdomen-pelvis to indicate any possibility of TB.

Please suggest the diagnosis, further tests & treatment, any possibility of malignancy?
XXXXX
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Answered by Dr. Tushar Kanti Biswas (31 hours later)
Brief Answer:
Prolonged fever -most likely infective origin

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Most likely in view of illness for 2 months with irregular fever ,weight loss ,WBC showing predominant lymphocytes,HRCT showing rt hilar lymph node enlargement possibility of Tuberculosis is strong.
Further investigation suggested QuantiFERON®-TB Gold- a blood test and also Brucella agglutination test in view of prolonged fever and mild/borderline splenomegaly to exclude Brucellosis.Typhoid fever is unlikely to persist beyond 04 weeks.







Regards

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

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1920 Questions

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What causes persistent low grade fever, weight loss and excessive weakness?

Brief Answer: Prolonged fever -most likely infective origin Detailed Answer: Hi, Thank you for your query. I can understand your concerns. Most likely in view of illness for 2 months with irregular fever ,weight loss ,WBC showing predominant lymphocytes,HRCT showing rt hilar lymph node enlargement possibility of Tuberculosis is strong. Further investigation suggested QuantiFERON®-TB Gold- a blood test and also Brucella agglutination test in view of prolonged fever and mild/borderline splenomegaly to exclude Brucellosis.Typhoid fever is unlikely to persist beyond 04 weeks. Regards Dr. T.K. Biswas M.D. XXXXXXX