Unexplained Fever: Navigating Persistent High Temperatures and Symptoms

Fever of unknown origin?

Hello doctor, since July until now (August 26), my body temperature has been consistently elevated.
The lowest temperature in July was 37.2°C, and it intermittently rose to 38°C.
After a while, I started experiencing gastrointestinal discomfort, vomiting everything I ate, which led me to the emergency room where I was admitted for blood tests.
The doctor mentioned that my white blood cell count was slightly elevated, indicating mild inflammation.
After several blood tests with similar results, I was prescribed antipyretics and discharged.

Later, I suddenly developed conjunctivitis, and my lymph nodes became swollen, with a fever reaching 38.5°C.
I visited a clinic and was told it was a cold.
The symptoms persisted, so I went to a large hospital and consulted a pediatrician.
A bacterial culture revealed that I had an adenovirus infection.
The doctor said I would likely have a fever for about a week, but after a week, the fever did not subside.
My temperature has been fluctuating from 37.2°C to 37.5°C, occasionally reaching 38°C.

I was hospitalized for a week, underwent numerous blood tests, and had stool cultures done, but we still couldn't determine the cause of the persistent fever.
I am currently waiting for the TST results on Monday and the SLE test results from last week.
The pediatrician mentioned that if the CRP, ESR, and WBC levels do not show significant abnormalities this time, I would just continue to receive antipyretics to alleviate the discomfort from the fever.
Aside from the fever and headache, I have no other symptoms.
I really don't know what to do.
Should I be referred to an infectious disease specialist for further evaluation?

Niming, 10~19 year old female. Ask Date: 2018/08/26

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, it is possible that the fever is caused by some atypical infections or non-infectious conditions.
There are indeed many potential reasons for this, and a detailed examination is necessary.
If the fever persists, I recommend visiting an infectious disease clinic for further evaluation.
Thank you for your inquiry.

Reply Date: 2018/08/26

More Info

Unexplained fever can be a challenging and concerning symptom, especially when it persists over an extended period. In your case, it appears that you have been experiencing elevated body temperatures since July, with fluctuations between 37.2°C and 38.5°C, accompanied by gastrointestinal discomfort and other symptoms. The fact that you have undergone multiple tests, including blood tests and cultures, without a definitive diagnosis can be frustrating and worrisome.

Fever is a common response of the body to infection, inflammation, or other underlying conditions. In your situation, the elevated white blood cell count and the diagnosis of adenovirus suggest that your body is responding to some form of infection. Adenovirus can cause a range of symptoms, including respiratory issues, conjunctivitis (as you mentioned with your eye symptoms), and gastrointestinal disturbances. While adenovirus infections are typically self-limiting, they can sometimes lead to prolonged symptoms, especially in individuals with underlying health conditions or weakened immune systems.

The persistence of your fever, despite treatment and monitoring, raises several possibilities. One potential explanation could be a post-viral syndrome, where symptoms linger even after the initial infection has resolved. Another consideration is the possibility of a secondary infection or another underlying condition that has not yet been identified. Conditions such as autoimmune diseases, malignancies, or chronic infections (like tuberculosis) can sometimes present with unexplained fevers and require further investigation.

Given your ongoing symptoms and the lack of a clear diagnosis, it would be prudent to consult with an infectious disease specialist. They can provide a more comprehensive evaluation and may recommend additional tests, such as imaging studies or more specialized blood tests, to rule out other potential causes of your fever. It is essential to communicate all your symptoms and the timeline of your illness to the specialist, as this information can help guide their assessment.

In the meantime, managing your symptoms is crucial. Continue to monitor your temperature and take antipyretics (like ibuprofen) as prescribed to help alleviate discomfort. Staying hydrated and maintaining a balanced diet can also support your recovery. If you experience any new or worsening symptoms, such as difficulty breathing, severe abdominal pain, or persistent vomiting, seek medical attention promptly.

In summary, while your symptoms may be frustrating and concerning, there are steps you can take to address your situation. Consulting with an infectious disease specialist for further evaluation and testing is a reasonable next step. They can help identify the underlying cause of your persistent fever and guide you toward appropriate treatment. Remember to advocate for yourself and communicate openly with your healthcare providers about your concerns and symptoms.

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