Unexplained High Fever and Severe Headache: Possible Neurological Issues

Unexplained high fever and headache?

Hello, Doctor.
On the morning of September 6th, I experienced a sudden high fever reaching 40 degrees Celsius, accompanied by severe headaches.
After taking antipyretics, my temperature dropped to 38 degrees but did not return to normal.
I did not have any cold symptoms (such as nasal congestion, cough, or sore throat), and I went to the emergency room that afternoon.
Emergency tests revealed a white blood cell count of 25,000 and an inflammatory index of 30.
A CT scan showed no abnormalities, and I was prescribed antibiotics and other medications to rest at home.
Although the fever subsided, the headache persisted.

On the morning of September 9th, I had another fever reaching 38 degrees, and despite continuous use of antibiotics and pain relievers, the headache remained.
Therefore, I returned to the emergency room.
Further tests showed a white blood cell count of 22,000 and an inflammatory index of 24.
I also reported lower back pain on both September 6th and 9th, and on September 9th, I was unable to bend over.
After receiving an antibiotic injection in the emergency room on September 9th, the doctor determined that I could go home since the fever had subsided.
However, today (September 10th), the headache persists, and I have noticed purulent discharge from the urethral opening, although urination is not painful.
Current status: No fever, persistent headache, lower back pain, urethral discharge (white), slight dizziness, occasional visual disturbances, and difficulty taking deep breaths.
The emergency physician advised me to consult a neurologist, but all nearby hospitals' neurology departments are fully booked and not accepting appointments.
I would like to ask the doctor what my current condition might indicate, whether the referral to the correct specialty is appropriate, and if it is necessary to travel to a medical center in another city.

Zheng, 20~29 year old female. Ask Date: 2019/09/11

Dr. Jiang Junyi reply Neurology

Hello,
I apologize for the late response to your question.
You mentioned experiencing headaches, lower back pain, white discharge from the urethra, mild dizziness, occasional visual disturbances, and difficulty taking deep breaths.
These symptoms may suggest an infection, particularly a urinary tract infection.
However, urinary tract infections are less common in males, so it is important to consider sexually transmitted infections as a potential diagnosis.

Since infections can be acute, if your symptoms persist, it is advisable to seek emergency medical care.
You may also need to consult a neurologist for the related symptoms.
Neurology clinics primarily manage chronic conditions or mild cases.
If appointments are fully booked, the emergency department may coordinate with the on-call neurologist for assistance.

It is not recommended to seek care across counties, as the culture of the pathogen is crucial for diagnosing infections.
If a referral to a medical center is necessary, it is best to have a physician evaluate the required assistance before transferring you.

Wishing you good health and well-being.

Dr.
Jiang, Taoyuan Medical Center, cares about you.

Reply Date: 2019/09/11

More Info

Based on your symptoms and the medical history you've provided, it appears that you are experiencing a complex set of issues that may involve both infectious and neurological components. The combination of high fever, severe headache, elevated white blood cell count, and inflammatory markers suggests that there may be an underlying infection that needs to be addressed.
Firstly, the high fever (up to 40 degrees Celsius) and severe headache are concerning symptoms that warrant thorough investigation. The fact that you experienced a significant drop in fever with antipyretics but could not return to normal temperature indicates that your body is likely fighting an infection. The elevated white blood cell count (25,000 and later 22,000) and inflammatory markers (30 and 24) further support this notion, suggesting an ongoing inflammatory or infectious process.

Given the absence of typical respiratory symptoms (like cough or sore throat), it is essential to consider other potential sources of infection. The presence of lower back pain and white discharge from the urethra raises the possibility of a urinary tract infection (UTI) or even a more complicated condition such as pyelonephritis, especially since you mentioned that you have had difficulty bending over due to pain. Infections can sometimes present with atypical symptoms, and in males, UTIs can occur, although they are less common than in females.

The ongoing headache, even after the fever has subsided, is particularly concerning. It could be a result of several factors, including dehydration, persistent inflammation, or even a secondary effect of the infection. Neurological issues cannot be ruled out, especially if the headache is severe and persistent. Symptoms like dizziness and occasional visual disturbances (like "seeing stars") can also indicate increased intracranial pressure or other neurological concerns.

In terms of next steps, it is crucial to follow up with a healthcare provider who can perform a more comprehensive evaluation. Since you have been advised to see a neurologist but are facing difficulties with scheduling, consider the following options:
1. Emergency Care: If your symptoms worsen or if you experience new symptoms such as confusion, severe dizziness, or changes in vision, seek immediate medical attention. Emergency departments can often facilitate consultations with specialists.

2. Primary Care Provider: If you have a primary care physician, they can help coordinate your care and may be able to refer you to a neurologist or another specialist more quickly.

3. Cross-County Referral: If local options are limited, it may be necessary to seek care at a medical center in another county. While this may seem inconvenient, your health is paramount, and a larger facility may have the resources and specialists available to address your concerns.

4. Urological Evaluation: Given the urinary symptoms, it may also be beneficial to consult a urologist to rule out any urinary tract issues that could be contributing to your symptoms.

In conclusion, your symptoms warrant a multi-faceted approach to diagnosis and treatment. It is essential to address both the potential infection and any neurological concerns. Do not hesitate to seek further medical attention if your symptoms persist or worsen, as timely intervention can be crucial in managing your health effectively.

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