Persistent Fever for Three Weeks: What Specialist Should You Consult?

Recurrent fever for three weeks?

My sister, who is 25 years old, developed a fever at the end of April and sought medical attention.
Initially, she had a sore throat, and the ENT doctor diagnosed her with a cold.
After taking medication for three days, her fever did not subside, so she returned for a follow-up.
During the second visit, she reported pain and swelling in both sides of her jaw and neck, and the doctor diagnosed her with tonsillitis.
Despite taking medication, she continued to experience recurrent fevers.

On her third visit, she switched to an internal medicine clinic, where the doctor ordered blood tests.
The results showed normal but slightly low white blood cell counts and anemia, leading to a preliminary diagnosis of an autoimmune disease.
She was prescribed medication for three days, which included antibiotics, anti-inflammatory drugs, and medication for runny nose.

During her fourth visit, she reported headaches and was given another three-day course of medication.
While taking the medication, she did not have a fever but experienced headaches, back pain, and swollen gums.
After finishing the three-day course, her fever returned, and this has been ongoing for nearly 20 days.

I would like to know which specialty she should consult next.
During her fever, she has some energy but feels slightly fatigued.
She can work while on medication, but the side effects seem to include dizziness and weakness.

Miss Zhang, 20~29 year old female. Ask Date: 2021/05/11

Dr. Lin Wufu reply Internal Medicine

It sounds most like an autoimmune issue.
I recommend consulting a rheumatologist, but many details still need to be assessed in person by your sister.
You might also consider seeing an infectious disease specialist for further evaluation regarding the unexplained fever.
If it is confirmed to be an autoimmune problem, we can assist with a referral.
Just for your reference!

Reply Date: 2021/05/11

More Info

When dealing with persistent fever, especially one that lasts for three weeks, it is crucial to approach the situation methodically. Your sister's case, characterized by recurrent fever, throat pain, and swollen lymph nodes, indicates that there may be an underlying issue that requires further investigation. Given the complexity of her symptoms and the various diagnoses she has received, it is essential to consider a few key points.

Firstly, persistent fever can be caused by a variety of conditions, including infections, autoimmune diseases, malignancies, and other inflammatory processes. In your sister's case, the initial diagnosis of a common cold followed by a diagnosis of tonsillitis suggests that the healthcare providers are considering infectious causes. However, the persistence of her symptoms despite treatment raises the possibility of a more complex underlying condition.

Given that her blood tests indicated low white blood cell counts and anemia, these findings warrant further evaluation. Autoimmune diseases, such as lupus or rheumatoid arthritis, can present with fever and systemic symptoms, and they often require specialized care. Therefore, it would be prudent for your sister to consult a rheumatologist, a specialist who focuses on autoimmune diseases and conditions affecting the joints and connective tissues.

Additionally, if her symptoms persist or worsen, it may also be beneficial for her to see an infectious disease specialist. These specialists are trained to diagnose and manage complex infections that may not respond to standard treatments. They can conduct more specific tests to identify any underlying infections that may be causing the persistent fever.

In the meantime, it is essential for your sister to maintain open communication with her healthcare providers. Keeping a detailed record of her symptoms, including the duration of fever, associated symptoms (such as fatigue, pain, or swelling), and any medications taken, can provide valuable information for her doctors. This information can help guide further diagnostic testing and treatment decisions.

In summary, your sister should consider consulting a rheumatologist to evaluate the possibility of an autoimmune condition, as well as an infectious disease specialist if her symptoms do not improve. It is crucial to address persistent fever seriously, as it can be a sign of a more significant health issue. Early and appropriate intervention can lead to better outcomes and a clearer understanding of her health status. Encourage her to seek these consultations promptly to ensure she receives the care she needs.

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