Recurrent Unexplained Fever in Older Adults

Recurrent unexplained fever

Hello, Dr.
Liao.
My mother is 64 years old.
Initially, she often felt fatigued and would become short of breath when climbing stairs, but she was fine walking on flat ground (even for 1-2 kilometers).
Initially, the local clinic suspected a heart issue, but after undergoing all relevant cardiac tests (chest X-ray, coronary angiography, pulmonary function tests, and blood tests), everything came back normal.
Recently, while taking my child's temperature during a cold, we discovered that my mother's temperature rises to around 37.8 to 38.3 degrees Celsius every day around 5 PM (this has been consistently measured for over a month).
She then visited the family medicine and infectious disease departments at a major hospital, where she underwent another chest X-ray, blood tests, urinalysis, sputum tests, and bacterial cultures, all of which returned normal results.
However, for nearly six months now, she has been experiencing unexplained fevers around 5 PM that resolve by the next day.
Recently, she has been monitoring her blood pressure regularly, and there have been no significant differences before and after the fever.
During this period, she has taken medications related to heart health, diuretics, and laxatives as prescribed by her doctor.
My mother also experiences constipation and edema in her legs.
She is approximately 160 cm tall and weighs about 55 kg.
Could you please provide some advice?

alex, 40~49 year old female. Ask Date: 2018/04/24

Dr. Liao Yaopan reply Family Medicine

Hello, regarding your question, the most common cause of fever is still infection.
Other causes need to be investigated, such as autoimmune diseases and tumors.
Please note: online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2018/04/24

More Info

Recurrent unexplained fever in older adults can be a challenging clinical scenario, especially when the underlying cause remains elusive despite extensive testing. In your mother's case, her symptoms of fatigue, shortness of breath when climbing stairs, and the recurrent fever occurring around the same time each day warrant a thorough evaluation.
Firstly, it is essential to understand that fever in older adults can be caused by a variety of factors, including infections, malignancies, autoimmune disorders, and even drug reactions. Infections are the most common cause of fever, but in older adults, they may present atypically. Given that your mother has undergone multiple tests, including chest X-rays, blood tests, urinalysis, and sputum cultures, and all have returned normal, it may be time to consider less common causes or revisit previous evaluations.

One possibility is a chronic infection that may not have been detected in standard tests. For instance, conditions like tuberculosis or certain viral infections can sometimes evade detection in initial screenings. Additionally, autoimmune disorders such as temporal arteritis or polymyalgia rheumatica can also present with fever and systemic symptoms, particularly in older adults.
Another consideration is the phenomenon known as "fever of unknown origin" (FUO), which is defined as a fever higher than 38.3°C (101°F) that lasts for more than three weeks without an identified cause after initial investigation. In such cases, further diagnostic workup may include imaging studies like CT scans or MRIs, and possibly even a bone marrow biopsy if hematological issues are suspected.

Given your mother's history of fatigue and shortness of breath, it may also be worthwhile to explore potential cardiac issues further, even if initial tests were normal. Sometimes, conditions like heart failure can present with subtle symptoms and may require more specialized testing, such as echocardiograms or Holter monitoring, to assess heart function and rhythm over time.

In terms of management, it is crucial to maintain a detailed symptom diary, noting the timing, duration, and any accompanying symptoms of the fever. This information can be invaluable for healthcare providers in identifying patterns or triggers. Additionally, ensuring that your mother stays well-hydrated and comfortable during fever episodes is essential.

As for the medications she is currently taking, it is worth discussing with her healthcare provider whether any of these could be contributing to her symptoms. Diuretics, for instance, can lead to electrolyte imbalances, which might cause fatigue and other systemic symptoms.

In conclusion, recurrent unexplained fever in older adults requires a comprehensive approach that includes a detailed history, thorough physical examination, and possibly further diagnostic testing. It may be beneficial to consult with a specialist in infectious diseases or geriatrics, who can provide a more focused evaluation and management plan tailored to your mother's specific situation. If her symptoms persist or worsen, seeking a second opinion or referral to a specialized center may also be warranted.

Similar Q&A

Understanding Unexplained Fever in Elderly Patients: Causes and Solutions

My grandfather is over 90 years old and has been feeling unwell since he fell a few months ago. He went to the hospital for examinations, but no cause was found. Later, he started experiencing recurrent fevers. He previously underwent surgery related to urinary difficulties, whic...

Dr. Fang Sijie reply Family Medicine
Dear Claire, Since I am unable to see your grandfather directly, I cannot diagnose the cause of his fever. There are many reasons for fever, with infections being the most common, followed by cancer (of course, there are other causes, but these two are the most frequent). You ma...

Unexplained Recurring Fever: A Gastroenterology Case Study

Hello Doctor, my mother is 62 years old. Since returning from a trip to Europe at the beginning of the year, she has had a poor appetite and has lost weight (from 60 kg to 50 kg). She says she is not accustomed to European food, but she also has experienced recurrent fevers (arou...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
Please visit the infectious disease department and undergo nuclear medicine scanning if necessary.

Understanding Recurrent Fever: Causes and Concerns in Adults

Hello Doctor: Two years ago, on October 10th, while I was walking with a friend after visiting a night market, I started to feel pain in the back of my head, which then radiated to my back. Generally, I experience pain in the back of my head when I am very tired, but it usually r...

Dr. Liao Zhongxin reply Internal Medicine
Hello Nancy: 1. The fever and headache on October 10, 2005, may indicate a viral infection, possibly even symptoms of a central nervous system infection. After treatment (such as intravenous fluids and medication), the white blood cell count quickly rose from over 1000 to 4000,...

Understanding Unexplained Fever: Causes and Solutions

I have been experiencing unexplained fevers every afternoon for the past six months, from November 1998 to May 1999. Despite undergoing various tests, no cause has been identified, and I have not had any relief from the fever during this time. I would like a physician's assi...

Dr. Guo Hanyue reply Internal Medicine
Hello: There are many possible causes for fever of unknown origin, and if it lasts for six months, it is generally unlikely to be due to a bacterial or viral infection. It is advisable to consult a dedicated infectious disease specialist to discuss the situation and evaluate the ...