Persistent Low-Grade Fever in Patients with Chronic Conditions

Q: Persistent Low-Grade Fever in Patients with Chronic Conditions

Hello： Regarding your symptoms of fever and discomfort, it is essential to first consider the possibility of an infection. <br>Currently, the prevalence of COVID-19 is high. <br>If your rapid test result is negative but you continue to feel unwell, it is advisable to visit a hosp

Elevated body temperature?

A little over a week ago, I had a fever of 38 degrees Celsius at midnight, and I was awakened from sleep by pain in my hand joints.
In the morning, my temperature remained at 38 degrees, and I had no appetite.
At the hospital, my tests showed SEG neutrophils at 85.3, LYM at 10.7, and ketones at 2+.
After taking antipyretics at home, my fever successfully subsided.
However, for the past two days, I have been experiencing persistent low-grade fever, with temperatures fluctuating between 37.4 and 37.7 degrees Celsius.
I feel fatigued and have a headache; at 37.7, I also feel a sense of heaviness.
Occasionally, I experience a brief sensation of tightness in my chest.
A rapid COVID-19 test showed one line.
I am unsure if this is due to an infection.
I have a history of Crohn's disease, seronegative spondyloarthritis, and Sjögren's syndrome, and I am currently using biologics, Pentasa, and Wankesi.

Qiao, 20~29 year old female. Ask Date: 2022/10/01

Dr. Lin Zhebin reply Family Medicine

Hello: Regarding your symptoms of fever and discomfort, it is essential to first consider the possibility of an infection.
Currently, the prevalence of COVID-19 is high.
If your rapid test result is negative but you continue to feel unwell, it is advisable to visit a hospital for a physician's evaluation to determine whether a PCR test is necessary, as it is more accurate for detecting COVID-19 than a rapid test.
Additionally, infections in other parts of the body should also be considered, especially since you are using immunosuppressants, which increases your risk of infection compared to the general population.
Furthermore, it is important to consider whether there may be issues related to endocrine disorders or changes in your autoimmune conditions (such as Crohn's disease, seronegative spondyloarthritis, or Sjögren's syndrome).
Therefore, I recommend that you return to the clinic of the physician who originally managed your chronic conditions for further evaluation and treatment by someone familiar with your medical history.

Reply Date: 2022/10/01

More Info

Persistent low-grade fever can be a perplexing symptom, especially in patients with chronic conditions such as Crohn's disease, seronegative spondyloarthritis, and Sjögren's syndrome. Understanding the underlying causes and implications of a low-grade fever in these contexts is crucial for effective management and treatment.

Low-grade fever is generally defined as a body temperature ranging from 37.3°C to 38.5°C (99.1°F to 101.3°F). In your case, the fluctuating temperatures between 37.4°C and 37.7°C, along with accompanying symptoms such as fatigue, headache, and occasional heart palpitations, warrant a thorough investigation. The presence of elevated neutrophils (85.3) and ketones (2+) in your lab results suggests that there may be an underlying inflammatory or infectious process at play.

In patients with chronic inflammatory conditions like Crohn's disease, the immune system is often dysregulated. This can lead to a persistent inflammatory state, which may manifest as low-grade fever. Additionally, medications such as biologics (e.g., Remicade) and immunosuppressants can alter immune responses, making patients more susceptible to infections or complicating the presentation of existing infections. It's essential to consider the possibility of infections, particularly opportunistic infections, which can occur in patients on immunosuppressive therapy.

Moreover, the symptoms you describe, including joint pain and lack of appetite, could indicate a flare-up of your underlying conditions. Inflammatory diseases can cause systemic symptoms, including fever, due to the release of pro-inflammatory cytokines. The fact that you experienced a higher fever (38°C) at night, combined with joint pain, suggests that your body may be responding to an inflammatory trigger, which could be related to your chronic conditions or an acute infectious process.

Given your medical history and current symptoms, it is advisable to follow up with your healthcare provider for further evaluation. This may include additional blood tests to assess inflammatory markers (such as C-reactive protein or erythrocyte sedimentation rate), imaging studies to evaluate for any potential sources of infection, and possibly a referral to a specialist in infectious diseases or rheumatology.

In the meantime, managing your symptoms is essential. Staying well-hydrated, resting, and taking antipyretics as needed can help alleviate discomfort. However, it is crucial to monitor your symptoms closely. If you experience worsening symptoms, such as increased fever, severe fatigue, or new symptoms like shortness of breath or chest pain, seek medical attention promptly.

In conclusion, persistent low-grade fever in patients with chronic conditions can arise from various factors, including underlying disease activity, infections, or medication side effects. A comprehensive evaluation by your healthcare provider is necessary to determine the cause and appropriate management strategies. Your health and well-being are paramount, so do not hesitate to reach out for medical support as needed.

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