Fever Symptoms: When to Seek Medical Attention

Fever symptoms

Hello Dr.
Hong: I started experiencing chills and high fever ranging from 38.5 to 40.1 degrees Celsius on February 14.
Therefore, I went to the outpatient department for hospitalization on February 17, where I underwent the following tests: blood tests (including cultures), urinalysis, lumbar puncture (including cultures), brain CT (without contrast), chest and pelvic CT, chest X-ray, abdominal ultrasound, and at that time, my CRP level was over 8, while other tests were normal.
No bacteria were cultured from blood or cerebrospinal fluid.
During my hospitalization, the doctor treated me with intravenous antibiotics until my fever decreased to around 37.5 degrees Celsius on February 23.
I was discharged on February 25 and continued taking antibiotics (the doctor's diagnosis was atypical bacterial infection).

On the evening of March 1, I started experiencing high fever again, ranging from 38.5 to 39.3 degrees Celsius, which lasted for four days.
On March 6, I switched to another hospital for outpatient care, where blood tests showed a CRP level of over 7.
I was hospitalized again for further examination, which included blood tests (including cultures), urinalysis, brain CT (with contrast), brain MRI, echocardiogram, electrocardiogram, chest X-ray, abdominal ultrasound, gastroscopy, and nuclear medicine imaging (for bones and inflammation).
All these tests were normal.
During my hospitalization, I had a fever above 38.5 degrees Celsius every day and received intravenous antibiotics.
On the sixth day, March 11, my blood test showed a CRP level of over 5, while other results were normal.
That evening, I still experienced chills and fever reaching 38.5 degrees Celsius, and sometimes when my fever exceeded 38.5 degrees Celsius, I would vomit.
On March 12, the doctor started me on oral steroids at a dosage of 10 mg (2 tablets twice a day).
Initially, my average temperature was controlled at around 36.9 to 37.1 degrees Celsius.
On March 16, my blood test showed a CRP level of over 1, so I was discharged (the doctor's diagnosis was fever of unknown origin).
However, starting March 22, my temperature rose to 37.8 to 37.9 degrees Celsius, and I occasionally felt fatigued.

Could you please advise if the steroids I am taking are losing their effectiveness, and should I return to the hospital?

Xiao Bing, 30~39 year old female. Ask Date: 2021/03/23

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, it is indeed difficult to determine the cause of the fever of unknown origin.
There are a few points to consider:
First, rheumatological and immunological issues may be a concern, which is likely why your physician has suspected this and prescribed corticosteroids.

Second, hematological malignancies could be a possibility, and this may require a bone marrow biopsy.

Third, atypical infections, such as extrapulmonary tuberculosis, should also be considered.

However, all three of these points can be challenging to investigate.
If the fever persists, it is advisable to consult the infectious disease department at a medical center for further evaluation.
Thank you for your inquiry.

Reply Date: 2021/03/23

More Info

When dealing with persistent fever and associated symptoms, it is crucial to understand the underlying causes and when to seek medical attention. Your case presents a complex scenario of recurrent fever, which can be indicative of various medical conditions, including infections, autoimmune disorders, or malignancies.
From your description, it appears that you have experienced high fevers ranging from 38.5°C to 40.1°C, along with chills and subsequent hospitalizations for extensive testing. The tests you underwent, including blood tests, imaging studies, and lumbar puncture, were essential in ruling out serious conditions such as bacterial infections, central nervous system infections, and other systemic diseases. The fact that your CRP levels fluctuated but generally trended downwards is a positive sign, indicating a potential resolution of inflammation, but it does not eliminate the need for ongoing monitoring.

The use of antibiotics during your hospital stays suggests that your healthcare providers were concerned about a possible bacterial infection, even if cultures did not yield positive results. The diagnosis of "atypical bacterial infection" implies that the causative agent may not have been easily identifiable through standard testing methods. This can occur with certain pathogens that require specific culture techniques or are not routinely tested for.

The introduction of corticosteroids in your treatment regimen is noteworthy. Corticosteroids can help reduce inflammation and modulate the immune response, which may be beneficial in cases where an autoimmune process is suspected or when inflammation is contributing to your symptoms. However, it is essential to use these medications judiciously, as they can suppress the immune system and potentially lead to complications if not monitored properly.

Regarding your concern about the effectiveness of the corticosteroids, it is important to recognize that the dosage and duration of treatment can significantly impact their efficacy. If you are experiencing a resurgence of fever and fatigue, it may indicate that your underlying condition has not been fully resolved or that the corticosteroid dosage needs adjustment. It is also possible that your body is responding to the tapering of the medication, leading to a return of symptoms.

Given your ongoing symptoms, including the new onset of low-grade fever (37.8°C to 37.9°C) and fatigue, it is advisable to consult with your healthcare provider. They may recommend further evaluation to determine if there is an underlying infection that has not been addressed or if there are other factors contributing to your symptoms. This could include additional blood tests, imaging studies, or referrals to specialists, depending on the clinical findings.

In summary, persistent fever, especially when accompanied by other symptoms, warrants careful evaluation and management. Your history of recurrent fevers and the complexity of your case suggest that ongoing medical supervision is necessary. Do not hesitate to reach out to your healthcare provider to discuss your symptoms and the potential need for further investigation or adjustment of your treatment plan. Early intervention can be crucial in managing underlying conditions effectively and preventing complications.

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