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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes persistent fever?

well, my wife is having feveR from the past 17 days.initially it was 101-102 thten it progessed till 105 now its going uptill 103.she was treated with ceftriaxone1 gm BD or 5 days then tazobactom 4.5gm TID for 5 days.she developed skin rashes at the end of 4th day of ceftriaxone. right now she is under Ornifloxone+ofloxine from 3 days.fever comes daily twice in morning and evening.all tests r negative
dengue twice was negative, hepatitis b ,hepatitis c, hiv,widal,malaria v and f ,cbp,cue,lft were done
liver enzymes are high
bilirubin =3mg/dl
sgpt =220ou/l
sgot 35 ou/l
wbc = 10200
platelets 220000
rubella virus negative
weil felix negative
na =132
k =3.9
usg scaN HEPATOSPLENOMEGALY, THICKENED GALL BLADDE WITH PEICHOLECYSTIC EDEMA
CT SCAN OF CHEST NORMAL
PAUL BUNNEL TEST NEGATIVE
ANA NEGATIVE
PATIENT WAS CHRONIC ITP CASE. WAS TAKING STEROIDS FROM PAST 3 MONTHS.FIRST 20 DAYS SHE TOOK 40 MG PREDNISOLONE PER DAY
THEN 40 MG DEXAMETHASONE FOR 3 DAYS THEN TAPERING FOR 3 DAYS CONSTITUTING ONE BLOCK, THEN LEAVE A GAP OF A WEEK AND START DEXA BLOCK ONCE AGAIN.SHE TOOK 5 BLOCKS.
THEN SHE TOOK DAPSONE 100 MG FOR 20 DAYS.ON THE ONSET OF FEVER SINCE 9 AUG, DAPSONE IS DISCONTINUED.
INITIALLY IN FEVER SHE HAD VOMITINGS, BUT THEY HAVE SUBSIDED AFTER GIVING ONDESTRON
BP 110/70
PR 100
WEIGHT 60 KGS
NOW RASHES R GOING DUE TO PREDNISOLONE BUT FEVER COMES EVERY DAY.PLZ ADVISE.NO DIAGONASIS IS DONE.DOCTORS R EXPECTING VIRAL FEVER
Wed, 24 Sep 2014
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General & Family Physician 's  Response
Hello,Thanks for using HCM.
I went through the details of history,investigation and treatment of your wife.
One thing is striking me is hepatospleenomegaly with high fever, and its pattern, in my practice, in our region, is indicative of malaria or kala azar. Though the reports does not confirm but there is no harm in discussing with your doctor, as she is responding to none of the drugs. you can give reference of our conversation.
If it is septicemia then instead of trying various drugs, a blood culture and sensitivity can be tried.
Please let us know the progress of the case,we will also be benefited.
Our best wishes are with you.
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ENT Specialist Dr. Abubakar Siddiqh's  Response
hello, thanks for your query, I advice you to have simple paracetamol 500 mg thrice daily, as such ,viral fever self limiting, it takes time to resolve. mean time you can go for( to rule out missing diagnosis) blood culture followed by ct brain , if necessery csf analysis- viral encephalitis, hope I have answered your query. all the best. take care.
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