Persistent Low-Grade Fever: Possible Causes and Concerns - Internal Medicine

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Persistent low-grade fever can be a perplexing and concerning symptom, especially when it lasts for an extended period without clear signs of infection or illness. In your case, the fever has persisted from December 2 to December 14, with daily temperatures ranging from 37.6 to 38.6 degrees Celsius. Given your history of exposure to potentially contaminated water and the presence of a herpes simplex virus outbreak on your lips, it is essential to consider a variety of potential causes for your symptoms.

Firstly, low-grade fever can be a manifestation of several underlying conditions. Common causes include infections (both viral and bacterial), autoimmune diseases, malignancies, and even chronic inflammatory conditions. The fact that you have a history of Epstein-Barr virus (EBV) infection is noteworthy, as EBV can lead to chronic fatigue and low-grade fever in some individuals. Additionally, your elevated white blood cell count (14,000) and inflammatory markers (1.2) suggest that your body is responding to some form of stress or infection.

The ingestion of contaminated water could potentially introduce various pathogens into your system. Bacterial infections, particularly those caused by organisms found in water sources, can lead to gastrointestinal symptoms, but they may also present with systemic symptoms such as fever. It is also worth noting that certain sexually transmitted infections (STIs) can present with fever and systemic symptoms, even in the absence of other typical signs. However, you mentioned that there have been no risky sexual behaviors in the past three months, which may reduce the likelihood of STIs being the primary cause.

Herpes simplex virus (HSV) can cause localized infections, but it is less commonly associated with systemic symptoms like prolonged fever unless there is a more extensive infection or complications. The presence of herpes lesions may indicate a localized infection, but it is essential to consider whether there is a concurrent systemic infection that could be contributing to your fever.

In terms of differential diagnoses, it is crucial to rule out conditions such as tuberculosis, which can present with low-grade fever, night sweats, and weight loss, as well as other chronic infections. Autoimmune diseases, such as systemic lupus erythematosus (SLE) or rheumatoid arthritis, can also present with persistent low-grade fever and systemic symptoms. Malignancies, particularly lymphomas, can present with fevers of unknown origin, so this should also be considered.

Given the complexity of your symptoms and the duration of your fever, it is advisable to seek further medical evaluation. A thorough workup, including blood cultures, imaging studies, and possibly a referral to an infectious disease specialist, may be warranted. It is also essential to monitor for any new symptoms, such as weight loss, night sweats, or changes in appetite, as these could provide additional clues to the underlying cause of your fever.

In summary, persistent low-grade fever can arise from a variety of causes, including infections, autoimmune diseases, and malignancies. Your recent exposure to contaminated water and the presence of herpes lesions warrant further investigation to rule out potential bacterial infections or other underlying conditions. It is crucial to consult with a healthcare provider for a comprehensive evaluation and appropriate management.