Persistent Fever of 38°C for a Month: Seeking Answers Beyond Basic Tests

Persistent fever of 38 degrees Celsius for one month?

I started having a fever in early April.
The first emergency diagnosis was a urinary tract infection, but I didn't have any other discomfort aside from the fever.
I was prescribed antibiotics and antipyretics, but the fever persisted even after finishing the medication.
I went to another hospital for further examination, and there were no issues found (the previous urinary tract infection had also resolved).
However, I still continued to have a fever.
While observing my condition at home, I confirmed that aside from the fever, I had no other symptoms.
Later, I went to another hospital and underwent the same tests (blood and urine) as the previous two hospitals, and again, everything came back normal.
When I asked the doctors, they suggested it might still be related to the urinary tract.
However, I am still experiencing a persistent fever.
I would like to know what additional tests I could pursue beyond the basic examinations.
Thank you.

Qiao, 20~29 year old female. Ask Date: 2020/05/04

Dr. Liao Yaopan reply Family Medicine

Hello, you have been experiencing elevated body temperature for over a month, and it is indeed necessary to undergo further evaluation.
It is recommended that you visit a large hospital's infectious disease department to assess whether there may still be non-infectious causes.
If necessary, you may be referred to other specialties.
Please note that online consultations are not equivalent to in-person visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about your well-being.

Reply Date: 2020/05/04

More Info

Persistent fever, especially one that lasts for a month, can be a concerning symptom that warrants thorough investigation. In your case, it seems that you have already undergone several tests, including blood and urine analyses, which have not revealed any significant issues. This can be frustrating, especially when you are experiencing a persistent fever without any other accompanying symptoms.

First, it’s important to understand that fever is a complex physiological response that can be triggered by various factors, including infections, inflammatory conditions, malignancies, and even autoimmune diseases. Since your initial diagnosis pointed to a urinary tract infection (UTI), it is possible that the fever was initially related to that condition. However, the persistence of the fever after treatment raises the question of whether there is another underlying cause.

Given that you have already been treated with antibiotics and have had negative results from basic tests, here are some additional avenues you might consider exploring:
1. Infectious Diseases Consultation: Since your fever persists without a clear diagnosis, consulting with an infectious disease specialist may be beneficial. They can evaluate for less common infections that may not have been considered, such as atypical bacterial infections, viral infections, or even fungal infections.

2. Imaging Studies: Sometimes, infections or other conditions may not be evident through blood and urine tests alone. Imaging studies, such as an abdominal ultrasound or a CT scan, can help identify hidden sources of infection or other abnormalities, such as abscesses or tumors.

3. Autoimmune Disorders: If infections have been ruled out, it may be worth investigating autoimmune conditions. Tests for specific autoimmune markers (such as ANA, rheumatoid factor, or specific antibodies) can help identify conditions like lupus or rheumatoid arthritis, which can present with fever.

4. Malignancy Screening: Although it may be less likely, persistent fever can sometimes be associated with malignancies, such as lymphoma or leukemia. A thorough evaluation, including imaging and possibly a biopsy, may be warranted if there are any concerning signs.

5. Thyroid Function Tests: Hyperthyroidism can sometimes cause persistent fever and other systemic symptoms. A simple blood test can assess your thyroid hormone levels.

6. Chronic Inflammatory Conditions: Conditions like Still’s disease or other forms of chronic inflammation can present with persistent fever. A rheumatologist can help evaluate for these conditions.

7. Monitoring and Documentation: Keep a detailed log of your fever patterns, including times of day when the fever spikes, any associated symptoms, and any changes in your environment or lifestyle. This information can be invaluable for your healthcare provider in diagnosing the underlying cause.

8. Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another physician or specialist can provide new insights or alternative diagnostic approaches.

In summary, while persistent fever can be frustrating and concerning, there are several avenues for further investigation beyond basic tests. Collaborating closely with your healthcare providers and possibly seeking specialists in infectious diseases or rheumatology can help uncover the underlying cause of your symptoms. It’s essential to remain proactive in your healthcare and advocate for further testing if you feel it is necessary.

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