Unexplained Fever for Over a Year: Seeking Answers and Next Steps

Q: Unexplained Fever for Over a Year: Seeking Answers and Next Steps

Hello, I will address your questions one by one： <br>1. <br>If traditional Chinese medicine is ineffective in reducing your fever, should you continue seeking medical attention, and what direction should that take? From a Western medicine perspective, I personally believe that yo

Fever of unknown origin for over a year?

Hello Doctor, my condition started two years ago with unexplained fevers (ear temperature around 37.5 to 38.3 degrees Celsius).
I consulted an infectious disease specialist at the hospital and underwent various tests (including blood tests, urine tests, chest X-ray, abdominal ultrasound, and CT scan), all of which showed no issues.
Later, my temperature slightly decreased (around 37 degrees Celsius) and since I had no other symptoms, the doctor advised me not to return for follow-up.
This process lasted about 4 to 5 months, but after a few more months, I began to feel feverish again.
Since the situation was similar to before, I did not pay much attention to it, and it has continued for about a year without improvement.
The only main symptom is a sensation of heat in my body (mainly under the chest, armpits, and groin) when touched.
Apart from measuring my temperature right after waking up, it has been consistently around 37.5 to 38.3 degrees Celsius, sometimes a little higher but never exceeding 38.7 degrees.
Previously, I measured around 36.6 degrees right after waking up, but recently it has been slightly above 37 degrees.
I am currently seeking treatment from a traditional Chinese medicine practitioner and would like to ask the following: 1.
If the traditional Chinese medicine treatment does not effectively reduce my temperature, should I continue seeking medical attention, and what direction should I pursue? 2.
Do the results of the CT scan and other tests from two years ago still hold any reference value? 3.
What is the likelihood of having cancer or other serious illnesses?

Yu, 20~29 year old female. Ask Date: 2022/03/23

Dr. Lin Zhebin reply Family Medicine

Hello, I will address your questions one by one:
1.
If traditional Chinese medicine is ineffective in reducing your fever, should you continue seeking medical attention, and what direction should that take? From a Western medicine perspective, I personally believe that you should consider consulting for autoimmune diseases and endocrine disorders.
2.
Do the CT scan results from two years ago still hold any reference value? If your symptoms have changed in the past two years, I recommend undergoing a detailed examination again.
The CT scan from two years ago can be compared with the new results.
3.
What is the likelihood of having cancer or other serious illnesses? Cancer should certainly be considered, especially concerning hematological malignancies.
I would like to know if you have a family history or other symptoms such as weight loss.
Given your age of 20, the likelihood of cancer is low.
Additionally, the tests you previously underwent in the infectious disease department (blood tests, urinalysis, chest X-ray, abdominal ultrasound, CT scan) should largely rule out the possibility of cancer.
However, since those tests were conducted two years ago, I would still recommend a detailed examination based on your current condition.

Typically, when addressing a fever, the first step is to rule out infections, as uncontrolled infections can develop into serious conditions.
After that, other diseases should be considered, including the autoimmune and endocrine disorders mentioned in the first question, as well as cancer.
These conditions can also potentially progress to serious illnesses, so I advise you to identify the underlying cause as soon as possible.

Reply Date: 2022/03/23

More Info

Unexplained fever lasting over a year can be a perplexing and concerning issue. Your situation, characterized by recurrent low-grade fevers (37.5 to 38.3 degrees Celsius) and localized warmth in areas such as the chest, armpits, and groin, warrants a thorough evaluation. Here’s a comprehensive approach to your questions and concerns.

1. Continuation of Medical Evaluation: If traditional Chinese medicine (TCM) treatments are not yielding results, it is advisable to seek further medical evaluation. Given the persistence of your symptoms, a referral to a specialist, such as an infectious disease expert or a rheumatologist, may be beneficial. These specialists can conduct more targeted investigations to rule out autoimmune diseases, chronic infections, or other underlying conditions that might not have been identified in previous tests. It may also be worthwhile to consider a comprehensive review of your medical history and any changes in your symptoms over the past year.

2. Relevance of Previous Imaging and Tests: The CT scans and other diagnostic tests performed two years ago may still hold some relevance, but they should be interpreted in the context of your current symptoms. If your symptoms have evolved or worsened, repeating these tests could provide new insights. For example, if there are new symptoms or changes in your physical examination, imaging studies like a repeat CT scan or MRI may be warranted to look for any new developments, such as abscesses, tumors, or other abnormalities that could explain your ongoing fever.

3. Risk of Serious Conditions: While the likelihood of serious conditions such as cancer is generally low, especially in younger individuals without significant risk factors, it cannot be entirely ruled out. The fact that you have undergone extensive testing previously is reassuring, but it is essential to remain vigilant. Conditions such as hematological malignancies (e.g., lymphoma or leukemia) can sometimes present with unexplained fevers and may require specific blood tests, including a complete blood count (CBC) with differential, and possibly a bone marrow biopsy if indicated. Additionally, autoimmune disorders like systemic lupus erythematosus (SLE) or rheumatoid arthritis can also present with similar symptoms and should be considered.

In summary, your ongoing unexplained fever is a complex issue that requires a multifaceted approach. It is crucial to continue seeking medical advice, especially if your symptoms persist or worsen. A thorough re-evaluation by a healthcare professional, including possible repeat imaging and laboratory tests, is essential to rule out any serious underlying conditions. Furthermore, maintaining open communication with your healthcare providers about your symptoms and any changes you experience will help guide the diagnostic process effectively. Remember, early detection and intervention are key to managing any potential health issues.

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