Choosing the Right Specialist: Immunology, Infectious Disease, or Hematology?

Medical specialties

Hello, Director.
I would like to ask which department I should consult for the following situation: A few years ago, I was hospitalized for 9 days due to a high fever.
Blood tests and multiple examinations were conducted, but ultimately it was concluded as an unexplained fever.
The infectious disease physician noted that the only abnormal finding was my low white blood cell count (approximately 3500).
Subsequent follow-ups and multiple health check results have consistently shown this number, never exceeding 4000.
Since that illness, I have experienced intermittent low-grade fevers, with my normal ear temperature around 36.6°C, but I often feel dizzy, fatigued, and weak in my limbs for several days, with my ear temperature reaching 37.5°C, lasting for two to three days.
While this does not qualify as a fever, it does affect my daily life.
Additionally, after that illness, I have had recurrent vaginal candidiasis and angular cheilitis, with multiple visits to the clinic but seemingly never fully resolving.
The gynecologist and ENT specialist have suggested that I get my immune system checked.
I would like to know if I should first see a rheumatologist/immunologist, an infectious disease specialist, or a hematologist? Thank you.

ST, 20~29 year old female. Ask Date: 2021/03/02

Dr. Liao Yaopan reply Family Medicine

Hello, it is recommended to consult a rheumatologist for further evaluation.
Of course, recurrent infection issues should be appropriately treated.
Online consultations are not equivalent to in-person visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2021/03/02

More Info

Based on your detailed medical history and symptoms, it seems you are dealing with a complex situation that may involve multiple specialties. Your history of prolonged fever, low white blood cell count, recurrent infections, and persistent mild symptoms such as dizziness and fatigue suggests that a thorough evaluation by the right specialist is crucial.

Given the nature of your symptoms, you should consider starting with an Immunologist or a Rheumatologist. These specialists focus on the immune system and can evaluate whether there is an underlying autoimmune condition or immunodeficiency that could be contributing to your recurrent infections and low-grade fevers. Your history of recurrent candidiasis (yeast infections) and angular cheilitis (cracks at the corners of the mouth) may indicate an issue with your immune response, which could be assessed through specific blood tests and clinical evaluations.

An Infectious Disease (ID) specialist is also a viable option, especially since you have a history of high fevers and were previously evaluated by an ID doctor. They can help rule out any chronic infections or unusual pathogens that may not have been detected in earlier tests. Given that you have experienced recurrent infections, an ID specialist may provide insights into whether these infections are due to a primary immunodeficiency or if they are simply recurrent due to environmental factors or other underlying health issues.

Finally, a Hematologist could be consulted to further investigate your low white blood cell count. A persistently low white blood cell count (leukopenia) can be indicative of various conditions, including bone marrow disorders, autoimmune diseases, or even the effects of certain medications. A hematologist can perform additional tests to determine the cause of your leukopenia and whether it is contributing to your symptoms.

In summary, the best approach would be to start with an Immunologist to evaluate your immune function and any potential autoimmune conditions. If they find that your immune system is functioning properly, you can then consider seeing an Infectious Disease specialist to rule out chronic infections. If there are concerns about your blood counts, a referral to a Hematologist would be warranted.
In the meantime, it is essential to keep a detailed record of your symptoms, including the frequency and duration of your fevers, any associated symptoms, and any treatments you have tried. This information will be invaluable to the specialists in diagnosing your condition accurately.

Lastly, regarding your recurrent infections, maintaining a healthy lifestyle, including a balanced diet rich in vitamins and minerals, adequate hydration, regular exercise, and sufficient sleep, can support your immune system. If you have specific dietary restrictions or concerns, discussing these with a healthcare provider or a nutritionist may also be beneficial.
Overall, seeking a multidisciplinary approach will likely yield the best results in understanding and managing your health concerns.

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