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What causes profuse night sweats, chills and body pain?

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Posted on Tue, 14 Nov 2017
Question: 39 Male. I’ve had a fever up to 102.5 for 6 days now with chills and body aches. When I take ibuprofen, I feel completely normal. When bay wears off, it’s back to bad chills and body aches. Two nights of significant night sweats. No other symptoms. No pain anywhere. CBC was all normal. Negative chest x-ray. CMP was good. Very slight elevation of liver enzymes. Sed rate 43. Only other symptom bothering me is loud wooshing pulsatile tinnitus in my right ear. I was told about six weeks ago there was fluid in the ear, but have not had any pain or problems with it since. I had it looked at because it was itching and crackling, and I thought I had something stuck in there. Right tonsil has always been larger, and is not more swollen than usual, not does it hurt. But when I push inwards on the tonsil, the tinnitus goes away.
doctor
Answered by Dr. Panagiotis Zografakis (43 minutes later)
Brief Answer:
a viral infection probably

Detailed Answer:
Hello,

your case sounds a lot like viral infection although no diagnosis is possible from afar. You haven't mentioned C-reactive protein. Did you do this test too? A low value at least a couple of days after the initiation of symptoms usually means a viral infection. The normal CBC (although I haven't seen the report) is usually against bacterial etiology.

Some findings or symptoms that may indicate a more serious infection include the following:
- severe headache that won't go away even when the fever is gone
- faintness and low blood pressure
- rigor (uncontrollable tremor with the chills with rattling teeth, etc)
- any new symptom for example urinary tract symptoms like flank pain, urgency or frequency.

I don't believe it's your ears because a middle ear infection usually presents with pain and hearing deficits. Besides that such infections are much more likely to occur in young children. Adults do not usually have middle ear infections.

I hope you find my comments helpful!
If you'd like to provide additional details or require any clarification please use your follow-up questions to ask.

Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (16 minutes later)
I do get pretty significant rigor when the fever is coming on after the ibuprofen wears off, but it passes after the fever is elevated. I did not have a c-reactive drawn. They did do an HIV because I work in healthcare and that was negative. There is a blood culture pending.
doctor
Answered by Dr. Panagiotis Zografakis (13 minutes later)
Brief Answer:
if they've excluded a UTI then a viral etiology is likely

Detailed Answer:
The difference between rigor and chills is the uncontrollable element of rigor. Rattling teeth is characteristic and is almost always present. Rigor usually means more serious infection although common infections like influenza may present with rigor too.

If the doctors have excluded a urinary tract infection (negative urinalysis) then the most likely cause is a virus. Viral infections cannot be treated (except herpes and influenza but treatment is not indicated for all patients). That's what I can contribute to your case. I'll be glad to give you more information if you provide additional details...

If things are not better after a couple of days then reassessment might be necessary.

Best wishes for a speedy recovery!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (12 minutes later)
Urinalysis was normal other than trace proteins, and a negative flu swab. I’d definitely call it rigors from your definition. It’s pretty uncontrollable, with teeth chattering. It stops when my body temp is up. 6 days of fever is concerning, but negative white count seems reassuring. When the fever is down, I feel almost completely normal.
doctor
Answered by Dr. Panagiotis Zografakis (20 minutes later)
Brief Answer:
please read the complete answer

Detailed Answer:
I see. Although both a negative urinalysis and a negative flu swab do not exclude a UTI or influenza (unless PCR was done), they're very indicative that you don't have these disorders.

It's normal for the symptoms of rigor to stop after the temperature rises. It's neither a positive nor a negative event. Besides that having rigor (particularly when it's the sixth day since the infection presented) is concerning. The negative CBC does not always say the complete truth. Sometimes the white blood cells count may be normal or even low with very serious infections. Other indicators in the CBC may provide additional clues, so if you can upload the reports it may help me to have a better understanding of your condition.

So, if your condition continues to be unchanged reassessment is indicated. If you've seen any kind of improvement then perhaps you can wait a bit. A good indicator might be the maximum temperature. For example if you had 102.5F in the first 2-3 days then it started to decline then this lowering might indicate improvement.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (5 minutes later)
Component     Your Value     Standard Range
White Blood Cells     4.2 K/UL     3.8 - 11.0 K/UL
Red Blood Cells     5.05 M/UL     4.20 - 5.70 M/UL
Hemoglobin     14.3 GM/DL     13.2 - 17.0 GM/DL
Hematocrit     43.1 %     39.0 - 50.0 %
MCV     85.3 FL     80.0 - 100.0 FL
MCH     28.3 PG     27.0 - 34.0 PG
MCHC     33.2 GM/DL     32.0 - 37.0 GM/DL
RDW     13.1 %     11.0 - 15.5 %
Platelets     207 K/UL     150 - 400 K/UL
Differential Type     Automated      
Neutrophils %     72.4 %     40.0 - 75.0 %
Immature Granulocytes %     0.2 %     0.0 - 1.0 %
Lymphocytes %     17.3 %     15.0 - 48.0 %
Monocytes %     9.9 %     0.0 - 12.0 %
Eosinophils %     0.0 %     0.0 - 7.0 %
Basophils %     0.2 %     0.0 - 2.0 %
Neutrophils,Absolute     3.00 K/UL     1.90 - 7.40 K/UL
Immature Granulocytes Absolute     0.01 K/UL     0.00 - 0.05 K/UL
Lymphocytes, Absolute     0.72 K/UL     1.00 - 3.90 K/UL
Monocytes,Absolute     0.41 K/UL     0.00 - 0.80 K/UL
Eosinophils, Absolute     0.00 K/UL     0.00 - 0.50 K/UL
Basophils, Absolute     0.01 K/UL     0.00 - 0.10 K/UL
General Information
doctor
Answered by Dr. Panagiotis Zografakis (12 minutes later)
Brief Answer:
immature granulocytes

Detailed Answer:
The CBC would have been almost normal without the immature granulocytes. These cells are normally absent from peripheral blood. Although their number (and percentage) is very low and they do not fulfill the criteria of SIRS or sepsis, they do raise some concern.

So in conclusion, if you've seen substantial improvement, you can wait it out for a couple of days more. Otherwise reassessment would be required.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (3 days later)
Fevers persisted until today so far. I’ve been afebrile for 12 hours today after one dose of 600mg ibuprofen.
New blood work done today.
Sed rate- 55 up from 43
C-reactive 3.6
CBC unchanged from previous draw
Added on CMV pending
ASO titer - equivocal “higher than 200 less than 400”
Also will receive ultrasound of my neck in the morning for the pulsatile tinnitus in my right ear.
doctor
Answered by Dr. Panagiotis Zografakis (9 hours later)
Brief Answer:
viral infection more likely

Detailed Answer:
Being afebrile for 12 hours does not mean much because in most cases ibuprofen and similar drugs may 'hide' the fever until their effects wear off. If you remained afebrile for a complete 24 hour period without ibuprofen then this would have been something.

The low CRP (3.6 whether it's mg/dL or mg/L it's low - if it's neither then please let me know) is against bacterial infection so a viral etiology is the most likely scenario. ASO is not useful in acute infections. The elevated ESR may just mean a prolonged infection - it's not sky high nor is it normal, it's somewhere between.

If you have any other symptom besides the ones you've mentioned or other clinically useful information (like a recent bite, travel abroad, pain, rash or anything that might seem relevant) please let me know. In cases with protracted undiagnosed fever and no sign of improvement radiological testing might be the next best step. Chest X-ray and abdominal ultrasound scan are two useful and easy to do tests.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

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What causes profuse night sweats, chills and body pain?

Brief Answer: a viral infection probably Detailed Answer: Hello, your case sounds a lot like viral infection although no diagnosis is possible from afar. You haven't mentioned C-reactive protein. Did you do this test too? A low value at least a couple of days after the initiation of symptoms usually means a viral infection. The normal CBC (although I haven't seen the report) is usually against bacterial etiology. Some findings or symptoms that may indicate a more serious infection include the following: - severe headache that won't go away even when the fever is gone - faintness and low blood pressure - rigor (uncontrollable tremor with the chills with rattling teeth, etc) - any new symptom for example urinary tract symptoms like flank pain, urgency or frequency. I don't believe it's your ears because a middle ear infection usually presents with pain and hearing deficits. Besides that such infections are much more likely to occur in young children. Adults do not usually have middle ear infections. I hope you find my comments helpful! If you'd like to provide additional details or require any clarification please use your follow-up questions to ask. Kind regards!