Unexplained Fever, Nausea, and Loss of Appetite: When to Seek Further Medical Help

Fever of unknown origin, nausea, and loss of appetite?

Hello Doctor, I have been measuring my ear temperature between 37.3 and 37.6 degrees Celsius for the past few months, and I feel a heavy sensation in my head similar to having a fever.
I often feel nauseous in the morning and have poor appetite throughout the day.
I have visited the clinic three times, and each time I was diagnosed with a cold, but my symptoms have not improved after taking the medication.
I am wondering if I should go to the hospital for further tests.

Since February of last year, I have been experiencing recurrent abdominal bloating, and an ultrasound of my small intestine indicated that it is filled with gas.
During severe episodes, I can only eat one egg a day.
I have consulted many gastroenterologists, both Western and traditional medicine, but there has been no improvement.
In December of last year, I underwent an endoscopy, which revealed multiple areas of erosion, but there has been no improvement after taking medication.
Additionally, I have been dealing with recurrent urinary tract infections, which I have also been seeing doctors for.
I would like to know if my fever is related to these two issues and which specialist I should consult.
Thank you!

Niming, 20~29 year old female. Ask Date: 2020/02/14

Dr. Lin Wufu reply Internal Medicine

Hello, it is recommended to visit a family medicine clinic for an examination and to perform a urinalysis to confirm whether there is a urinary tract infection.
Bloating itself can cause a feeling of nausea, which may not necessarily be related to a urinary tract infection or fever, and may need to be addressed separately.

Reply Date: 2020/02/14

More Info

Unexplained fever, nausea, and loss of appetite can be concerning symptoms, especially when they persist despite treatment. Based on your description, it seems you have been experiencing these symptoms for several months, along with gastrointestinal issues and recurrent urinary tract infections (UTIs). Given the complexity and duration of your symptoms, it is advisable to seek further medical evaluation.

Firstly, let's address the symptoms you are experiencing. A persistent low-grade fever (37.3-37.6°C) can indicate an underlying infection or inflammatory process. The sensation of heaviness in your head and nausea, coupled with a decreased appetite, can be associated with various conditions, including infections, gastrointestinal disorders, or even systemic issues. The fact that you have been diagnosed with a cold multiple times without improvement suggests that there may be a more significant underlying issue that needs to be addressed.

Your history of gastrointestinal symptoms, including bloating and the findings from your small intestine ultrasound, indicates that there may be functional gastrointestinal issues at play. The presence of "gas" in the small intestine can be due to various factors, including dietary habits, food intolerances, or gastrointestinal motility disorders. The endoscopic findings of "multiple abrasions" could suggest gastritis or esophagitis, which may require further investigation and management.

Additionally, your recurrent urinary tract infections could be contributing to your overall symptoms. UTIs can sometimes cause systemic symptoms, including fever and malaise, especially if they are recurrent or not adequately treated. It's essential to ensure that these infections are being managed effectively, as persistent infections can lead to complications.

Given the complexity of your symptoms, I recommend the following steps:
1. Consult a Specialist: You should consider seeing a gastroenterologist for your gastrointestinal symptoms. They can perform further evaluations, such as additional imaging studies or endoscopic procedures, to determine the cause of your symptoms and recommend appropriate treatment.

2. Infectious Disease Evaluation: If your fever persists, it may be beneficial to consult an infectious disease specialist. They can help evaluate for any underlying infections that may not have been identified yet and guide appropriate testing and treatment.

3. Comprehensive Blood Work: Request a complete blood count (CBC), metabolic panel, and inflammatory markers (such as CRP or ESR) to assess for signs of infection or inflammation. This can provide valuable information about your overall health and help guide further investigations.

4. Holistic Approach: Consider discussing your symptoms with a primary care physician who can coordinate your care among specialists. They can help ensure that all aspects of your health are being addressed, including any potential connections between your gastrointestinal issues and recurrent UTIs.

5. Lifestyle and Dietary Modifications: In the meantime, consider keeping a food diary to identify any potential food intolerances or triggers for your gastrointestinal symptoms. Staying hydrated and maintaining a balanced diet can also support your overall health.

In summary, while your symptoms may initially seem to be related to a common cold, the persistence and complexity of your condition warrant further investigation. Seeking specialized care and comprehensive evaluation will be crucial in identifying the underlying cause of your symptoms and developing an effective treatment plan. Don't hesitate to advocate for your health and seek the necessary medical attention to address your concerns.

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