Persistent Low-Grade Fever: When to Seek Further Medical Evaluation?

Low-grade fever for four consecutive days?

Hello,
For the past four days, my axillary temperature has been between 36.4°C and 36.6°C (previously, it was mostly between 35.6°C and 35.9°C, and during my menstrual period, it peaked at 36.1°C).
However, when measuring my ear temperature, it has reached 37.5°C and 37.6°C, and during hot weather, the highest ear temperature was only 37.1°C.
Initially, I visited a clinic where the doctor noted mild redness in my throat and suboptimal intestinal motility, diagnosing me with a mild gastroenteritis, which was not considered a serious issue.
However, I have not experienced significant upper respiratory symptoms, vomiting, or diarrhea.
In the past, even with severe colds, I did not necessarily have an elevated temperature.
Now, although I feel symptom-free, my temperature remains slightly elevated.
Due to my chronic insomnia and a previous health check that revealed a low white blood cell count, I am concerned that the elevated temperature could be caused by other factors.
I would like to know if I should see an Infectious Disease specialist or a Rheumatology/Immunology specialist if the low-grade fever persists.
I look forward to your response.
Thank you.

Susan, 30~39 year old female. Ask Date: 2020/05/24

Dr. Zeng Guosen reply Internal Medicine

Hello, your body temperature is slightly elevated but not significantly high.
Due to the combined factor of a white blood cell count below the standard range, it is recommended that you first visit an infectious disease specialist.
The physician will evaluate the results of your tests and determine if a referral to another specialty is necessary.
Thank you for your question.

Reply Date: 2020/05/24

More Info

Persistent low-grade fever can be a concerning symptom, especially when it lasts for an extended period. In your case, you have been experiencing a slight elevation in body temperature, with axillary readings between 36.4°C and 36.6°C, and ear temperatures reaching up to 37.6°C. While your initial visit to the clinic suggested a mild gastrointestinal infection, the absence of significant respiratory symptoms or gastrointestinal distress raises some questions about the underlying cause of your fever.

First, it is essential to understand that a low-grade fever can result from various factors, including infections, inflammatory conditions, and even stress or fatigue. Given your history of chronic insomnia and previously noted low white blood cell counts, it is prudent to consider that your immune system may be reacting differently than expected. Chronic insomnia can lead to a weakened immune response, making you more susceptible to infections or inflammatory processes that might not present with overt symptoms.

If your low-grade fever persists, it is advisable to seek further medical evaluation. The choice between an infectious disease specialist or a rheumatologist (for autoimmune conditions) depends on the additional symptoms you may develop and the clinical judgment of your primary care physician. Here are some considerations for your next steps:
1. Infectious Disease Consultation: If your fever continues without a clear cause, an infectious disease specialist can perform more comprehensive evaluations, including blood tests, imaging studies, and possibly cultures to identify any hidden infections. They can also assess for conditions like chronic infections (e.g., tuberculosis, viral infections) that may not present with typical symptoms.

2. Rheumatology Consultation: If you experience symptoms such as joint pain, fatigue, or skin rashes, it may be worth consulting a rheumatologist. Autoimmune diseases can sometimes present with low-grade fevers and nonspecific symptoms. They can conduct tests for autoimmune markers and assess for conditions like lupus or rheumatoid arthritis.

3. Further Testing: Given your previous health history, it may be beneficial to repeat blood tests to monitor your white blood cell count and other inflammatory markers (like CRP or ESR). These tests can provide insight into whether there is an ongoing inflammatory process in your body.

4. Lifestyle Factors: Addressing your chronic insomnia is also crucial. Sleep deprivation can significantly impact your immune function and overall health. Consider discussing sleep hygiene practices or potential treatments with your healthcare provider.

5. Monitoring Symptoms: Keep a detailed log of your symptoms, including any changes in your temperature, new symptoms, or patterns that emerge. This information can be invaluable for your healthcare provider in determining the next steps.

In conclusion, while a low-grade fever can sometimes be benign, persistent symptoms warrant further investigation. Engaging with your healthcare provider to discuss your concerns and determine the appropriate specialist to consult is essential. Your health is paramount, and proactive measures can lead to a better understanding of your condition and appropriate management.

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