Low-Grade Fever with Gastroenteritis: Causes and Concerns

I would like to know if gastroenteritis can cause a persistent low-grade fever?

Hello, my issue is a bit complex, and I would appreciate it if the doctor could take some time to listen to my story.

1.
On May 7, I decided to visit an orthopedic department at a major hospital due to pain from plantar fasciitis (which has not healed for almost a year).
The examination results indicated bone spurs.
The doctor prescribed the following medications:
1.
CataFLAM 25 mg/tab (Diclofenac) - take 1 tablet three times a day.

2.
Tido (Tizanidine) - take 1 tablet three times a day.

3.
Solaxin 200 mg/tab (Methocarbamol) - take 1 tablet at night.

After taking these medications for four days (until May 10), I experienced black stools and significant stomach discomfort, so I stopped taking them.

2.
On May 11, due to a busy work schedule, I skipped lunch and only had a piece of bread and some sparkling water, which led to severe gastrointestinal discomfort that day.
Over the next few days, I occasionally experienced stomach pain, but it improved after eating.

3.
On May 15, feeling that my gastrointestinal issues persisted and experiencing work-related stress, I consulted a traditional Chinese medicine practitioner.
After taking herbal medicine, I felt some improvement in my gastrointestinal condition.

4.
On May 17, I believed that working from home and news exposure affected my gastrointestinal discomfort, leading to a loss of appetite and mild diarrhea (loose stools).
In the evening, I developed a fever of 37.5°C (99.5°F), so I visited a clinic.
The doctor suspected gastroenteritis and prescribed the following medications to be taken three times a day:
1.
Acetaminophen 500 mg
2.
WEISUFU
3.
Cimetidine 200 mg
4.
Vitabutyrimin
5.
Cefuroxime
After two days of medication, my stomach improved, but I occasionally experienced cramping in the lower abdomen.
During the day, I continued to have a low-grade fever ranging from 37.2°C to 37.4°C (99°F to 99.3°F) and excessive sweating.
At night, the fever would drop to 37°C (98.6°F), and in the morning, I would wake up with a temperature of 36.5°C to 36.8°C (97.7°F to 98.2°F).
However, after getting up and doing light activities (like brushing my teeth), my temperature would rise again to 37.2°C, followed by a day of low-grade fever.
5.
On May 20, due to the persistent low-grade fever and occasional cramping in the lower abdomen, I returned to the clinic.
The doctor assessed that it was still gastroenteritis, but for safety (since my area is a hotspot), he advised me to undergo a rapid COVID-19 test.
As of now, it has been over 24 hours, and I have not received any notification, so I pray that everything is fine.
I am still taking the same medications as before.

I have been measuring my temperature every hour and noticed that for the past five days, my temperature drops to 37.0°C (98.6°F) by 8 PM and then gradually decreases.
In the morning, it can reach 36.5°C, but after getting up and doing light activities, it rises again to 37.2°C, especially two hours after taking medication when it can go up to 37.4°C.
I feel very fatigued, and by meal times, it drops slightly to 37.0°C.
Today (May 21), my stomach no longer hurts, but I still have a persistent low-grade fever.
I called the clinic for advice and was told that 37.4°C is not considered a fever and is not a concern.
They mentioned that the nighttime drop in fever is likely due to the medication's effects.

I am confused; if the antipyretic medication is effective, why does it only work at night? Does it take time to accumulate in the body to be effective? Could this low-grade fever be caused by interactions between these medications? Since I see you have expertise in toxicology, I would like to consult you.
I understand that doctors are very busy lately, but if you have time, I would appreciate your assistance in clarifying these concerns.
Thank you!

Neko, 40~49 year old female. Ask Date: 2021/05/21

Dr. Liao Yaopan reply Family Medicine

Hello, based on the above description, the issue of gastroenteritis still needs to be properly addressed.
The recorded body temperature is within a reasonable range.
Additionally, with the recent hot weather, adequate hydration is essential.
There should be no concerns regarding the accumulation of medication.
Online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2021/05/21

More Info

Understanding low-grade fever in the context of gastroenteritis can be quite complex, especially when considering the various factors that may contribute to the symptoms you are experiencing. Based on your detailed account, it appears that you have been dealing with a series of gastrointestinal issues, including discomfort, low-grade fever, and changes in bowel habits, which have persisted for several days.

Firstly, it is important to recognize that a low-grade fever, typically defined as a body temperature between 37.2°C (99°F) and 38.3°C (100.9°F), can be a common response to infections, including viral or bacterial gastroenteritis. In your case, the fever seems to fluctuate throughout the day, which is not unusual. Many patients with infections experience variations in body temperature due to the body's natural circadian rhythms and the effects of medications.
The medications you have been taking, including acetaminophen, can indeed lower your fever, but their effects may vary based on the timing of administration and your body's response. For instance, if you take acetaminophen, you may notice a reduction in fever shortly after taking it, but as the medication wears off, your temperature may rise again. This cycle can create the impression that your fever is persistent when, in fact, it is a normal response to the medication's pharmacokinetics.

Regarding your gastrointestinal symptoms, the presence of black stools (melena) after taking certain medications raises concerns about potential gastrointestinal bleeding, which can occur with nonsteroidal anti-inflammatory drugs (NSAIDs) like CataFLAM. It is crucial to monitor any further gastrointestinal symptoms and consult your healthcare provider if you experience any additional concerning signs, such as persistent abdominal pain, vomiting, or changes in bowel habits.

The fact that you have been experiencing low-grade fever alongside gastrointestinal discomfort could suggest a viral gastroenteritis, especially if you have had symptoms like diarrhea and abdominal pain. However, bacterial infections or other gastrointestinal conditions could also be at play. The fact that your symptoms improved with traditional Chinese medicine indicates that your gastrointestinal tract may be sensitive to certain foods or medications, and stress can also exacerbate gastrointestinal symptoms.

As for your concerns about the low-grade fever being a result of medication interactions, it is less likely that the medications you are taking are causing the fever directly. However, the overall state of your health, including any underlying infections or inflammation, can certainly influence how your body responds to these medications.

In summary, it is essential to continue monitoring your symptoms closely. If your low-grade fever persists beyond a week or if you develop new symptoms, it would be prudent to follow up with your healthcare provider for further evaluation. They may recommend additional tests, such as blood work or imaging studies, to rule out any underlying conditions. Additionally, maintaining hydration and a balanced diet can support your recovery during this time. If you have any further concerns or if your symptoms worsen, do not hesitate to seek medical attention.

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