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What Could Cause Intermittent Debilitating Fever For About 10 Years In A 62-year-old Female?
Question: I am a 62 year old female. For the past 10 years I have had intermittent fevers (every 6-8 weeks, ranging between 100F - 104F). They do not seem to be caused by viruses. They tend to last 2-3 days. I sleep for days when I have them. They leave me weak, but I never have other symptoms except the fever. I am otherwise in good health. In 2016, I had a blood test while I was in a "fever mode" and the C-Reactive protein was way high. I can't find the test or I'd give you the exact number. Can you give me any hint about what is going on?
Brief Answer:
Discussion follows
Detailed Answer:
Hello,
A high CRP indicates an inflammatory process somewhere in the body. It may be from an infection, a collagen disease or even an occult malignancy.
If it returns to normal after the fever, it excludes the malignancy and is likely to be due to an infective process. There are certain viral infections and mycoplasma infections which cause recurrent episodes of fever.
There is also a condition called relapsing fever by a vector borne Borrelia. If these have not been looked into, you may discuss the same with your doctor.
Hope I have answered your query. Do get back to me if you have further queries.
Regards,
Dr. Noble Zachariah
Internal Medicine Specialist
Discussion follows
Detailed Answer:
Hello,
A high CRP indicates an inflammatory process somewhere in the body. It may be from an infection, a collagen disease or even an occult malignancy.
If it returns to normal after the fever, it excludes the malignancy and is likely to be due to an infective process. There are certain viral infections and mycoplasma infections which cause recurrent episodes of fever.
There is also a condition called relapsing fever by a vector borne Borrelia. If these have not been looked into, you may discuss the same with your doctor.
Hope I have answered your query. Do get back to me if you have further queries.
Regards,
Dr. Noble Zachariah
Internal Medicine Specialist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I got hold of my personal physician today, who suspects Malaria (I did travel to a Malaria prone country, XXXXXXX about the time this started.) In your opinion, are these symptoms malaria-related?
Doctor ordered a lab test for malaria and other issues.
Thank you for your input
Doctor ordered a lab test for malaria and other issues.
Thank you for your input
Brief Answer:
Less likely to be malaria.
Detailed Answer:
Hello,
Malarial fever usually occurs with a spike daily, every other day or once in 3 days depending on the type of the infecting Plasmodium. The classic pattern is chills and rigors preceding the fever and sweating following the fever. The fever does not abate for 6 to 8 weeks without specific treatment.
If you are from the Mediterranean or of Mediterranean descent, there is FMF (Familial Mediterranean Fever) which fits with your description of fever. It is usually associated with abdominal or chest pain.
I shall be interested in knowing your diagnosis when it is arrived at.
Hope I have answered your query. Let me know if I can assist you further.
Best wishes.
Regards,
Dr. Noble Zachariah
Internal Medicine Specialist
Less likely to be malaria.
Detailed Answer:
Hello,
Malarial fever usually occurs with a spike daily, every other day or once in 3 days depending on the type of the infecting Plasmodium. The classic pattern is chills and rigors preceding the fever and sweating following the fever. The fever does not abate for 6 to 8 weeks without specific treatment.
If you are from the Mediterranean or of Mediterranean descent, there is FMF (Familial Mediterranean Fever) which fits with your description of fever. It is usually associated with abdominal or chest pain.
I shall be interested in knowing your diagnosis when it is arrived at.
Hope I have answered your query. Let me know if I can assist you further.
Best wishes.
Regards,
Dr. Noble Zachariah
Internal Medicine Specialist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your comment on malaria, that makes sense.
My ethnic background is almost fully Celtic (Scottish-Welsh-Irish).
My primary doctor suggested an emergency room visit yesterday because the C-Reactive Protein was 300 and should be more like 40. He said my sed rate was also very high and my white cell count was slightly elevated. The ER staff took a chest X-ray and it looked like pneumonia to them. So they gave me an antibiotic, gave me lots of IV fluids, and now I'm home again. I feel much better today.
The problem is, this doesn't explain why I've been getting the fevers every 6-8 weeks for several years. It started when I got influenza in 2014. The first few bouts of recurring fever after I recovered from 'flu were diagnosed as post-viral syndrome. But over the past 4 years they have become worse and more frequent.
I saw a rheumatologist a couple of years ago who suggested it might be Muckle-Wells syndrome. She tested for the genetic variant, and I don't have it.
Let me know if you can shed any more light on the problem. You have been very helpful, and thank you.
My ethnic background is almost fully Celtic (Scottish-Welsh-Irish).
My primary doctor suggested an emergency room visit yesterday because the C-Reactive Protein was 300 and should be more like 40. He said my sed rate was also very high and my white cell count was slightly elevated. The ER staff took a chest X-ray and it looked like pneumonia to them. So they gave me an antibiotic, gave me lots of IV fluids, and now I'm home again. I feel much better today.
The problem is, this doesn't explain why I've been getting the fevers every 6-8 weeks for several years. It started when I got influenza in 2014. The first few bouts of recurring fever after I recovered from 'flu were diagnosed as post-viral syndrome. But over the past 4 years they have become worse and more frequent.
I saw a rheumatologist a couple of years ago who suggested it might be Muckle-Wells syndrome. She tested for the genetic variant, and I don't have it.
Let me know if you can shed any more light on the problem. You have been very helpful, and thank you.
Brief Answer:
Discussion continued.
Detailed Answer:
Hello,
It is possible that you have mycoplasma pneumonia in which the WBC count is not elevated much but CRP and ESR are. Hope you have received the appropriate antibiotic for the same.
A possible diagnosis for the fever is Periodic Fever Syndrome which is a manifestation of several auto inflammatory conditions. The influenza you had might have sparked the auto inflammatory reactions.
Hope I have answered your query.
Regards,
Dr. Noble Zachariah
Internal Medicine Specialist
Discussion continued.
Detailed Answer:
Hello,
It is possible that you have mycoplasma pneumonia in which the WBC count is not elevated much but CRP and ESR are. Hope you have received the appropriate antibiotic for the same.
A possible diagnosis for the fever is Periodic Fever Syndrome which is a manifestation of several auto inflammatory conditions. The influenza you had might have sparked the auto inflammatory reactions.
Hope I have answered your query.
Regards,
Dr. Noble Zachariah
Internal Medicine Specialist
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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