Recurrent Fever: Causes and Concerns in Adults

Q: Recurrent Fever: Causes and Concerns in Adults

Hello Nancy： <br>1. <br>The fever and headache on October 10, 2005, may indicate a viral infection, possibly even symptoms of a central nervous system infection. <br>After treatment (such as intravenous fluids and medication), the white blood cell count quickly rose from over 100

High fever

Hello Doctor: Two years ago, on October 10th, while I was walking with a friend after visiting a night market, I started to feel pain in the back of my head, which then radiated to my back.
Generally, I experience pain in the back of my head when I am very tired, but it usually resolves after a good night's sleep.
After returning home, I thought I would take a nap, believing it would be fine, but I began to feel increasingly unwell.
It was around 11 PM when my breathing became rapid, and I experienced severe soreness in my pelvis, buttocks, and thighs, along with uncontrollable shaking.
Later that night, I went to the emergency room, where my temperature was measured at 39.5 degrees Celsius, although there were no visible signs of fever.
They performed a blood test, and the results indicated a viral infection with my white blood cell count dropping to just over 1,000.
The doctor asked if I had undergone any health check-ups, as my previous blood test had shown a white blood cell count of over 4,000.
After several hours of IV fluids, I felt better, but the doctor warned that I might experience fever again and advised me to return for another blood test in a few days to check if my white blood cell count returned to normal.
After recovery, my white blood cell count indeed rose to over 5,000.
However, on the night of November 22nd last year, the same symptoms reappeared.
I was concerned that I might have another fever, so I took my temperature and found it to be 38.5 degrees Celsius.
I immediately went to the emergency room, where my temperature rose to 39.5 degrees Celsius upon arrival.
The nurses could not detect any signs of fever, and the attending physician was unsure of the cause of my fever, as I had no other symptoms.
Ultimately, I received IV fluids and felt better afterward.
I also had blood tests done, and the results came back normal.
The day before, I had seen a doctor due to bleeding from a mole, and I am unsure if this is related to my fever.
This issue is very important to me, as I have sought medical attention multiple times for rectal bleeding, and I feel anxious about sudden fevers.
I hope to avoid having these episodes once a year.
I would appreciate your insights on this matter.
P.S.
I have undergone a colonoscopy and abdominal X-ray, both of which were normal.

NANCY, 20~29 year old female. Ask Date: 2007/02/08

Dr. Liao Zhongxin reply Internal Medicine

Hello Nancy:
1.
The fever and headache on October 10, 2005, may indicate a viral infection, possibly even symptoms of a central nervous system infection.
After treatment (such as intravenous fluids and medication), the white blood cell count quickly rose from over 1000 to 4000, indicating that the body's immune response has recovered.

2.
The fever on November 22, 2006, is more indicative of a bacterial infection, potentially originating from a urinary tract infection or an abscess wound.
With appropriate medication (antibiotics) and wound care, recovery is expected.

3.
Not every infection has the same source.
If you feel unwell to the extent that it affects your ability to attend school or work, you should seek medical treatment promptly to prevent a minor illness from becoming a major one.

By Dr.
Liao Chong-Hsin, Changhua Hospital.

Reply Date: 2007/02/08

More Info

Recurrent fever can be a perplexing and concerning issue for many adults, particularly when the underlying cause remains elusive. Your experience of experiencing multiple episodes of high fever, accompanied by various symptoms, raises important questions about potential underlying health issues that may need to be addressed.

Fever is a common physiological response to infection, inflammation, or other medical conditions. In adults, recurrent fever can be classified as fever of unknown origin (FUO) when the cause remains undetermined after thorough investigation. The most common causes of recurrent fever include infections (both viral and bacterial), autoimmune diseases, malignancies, and other systemic conditions.

In your case, the initial episode of fever was attributed to a viral infection, which is consistent with the typical presentation of such illnesses. The drop in your white blood cell count (leukopenia) during the first episode suggests that your immune system was responding to the infection, which can sometimes lead to a temporary decrease in white blood cells. This is not uncommon during viral infections, as the body directs resources to fight off the invading pathogens.

The recurrence of similar symptoms and fever episodes, as you described, raises the possibility of several underlying conditions. Here are some considerations:
1. Infectious Causes: While your initial episode was linked to a viral infection, it's important to consider that other infections could be responsible for recurrent fevers. This includes atypical infections that may not present with classic symptoms, such as certain types of viral infections, tuberculosis, or even infections that are localized and not easily detectable.

2. Autoimmune Disorders: Conditions such as systemic lupus erythematosus (SLE), rheumatoid arthritis, or other autoimmune diseases can present with recurrent fevers. These conditions often involve periods of exacerbation and remission, and they can affect various organ systems, leading to a range of symptoms.

3. Malignancies: Certain cancers, particularly hematological malignancies like lymphoma or leukemia, can present with recurrent fevers. This is often due to the body's immune response to the cancer or due to infections that occur as a result of immunosuppression.

4. Other Systemic Conditions: Conditions such as hyperthyroidism, adrenal insufficiency, or even certain metabolic disorders can lead to recurrent fevers. These conditions may require specific tests to diagnose.

Given your history of gastrointestinal bleeding and the fact that you have undergone colonoscopy and imaging studies that returned normal results, it is crucial to continue monitoring your symptoms closely. The relationship between your gastrointestinal symptoms and recurrent fever should be evaluated further, as some gastrointestinal disorders can lead to systemic symptoms, including fever.

Recommendations:
1. Follow-Up with Healthcare Provider: It is essential to maintain regular follow-up with your healthcare provider. Given the recurrent nature of your symptoms, a comprehensive evaluation by an infectious disease specialist or a rheumatologist may be warranted.

2. Keep a Symptom Diary: Documenting your symptoms, including the timing, duration, and associated factors (such as dietary changes, stress levels, or recent illnesses), can provide valuable information to your healthcare provider.

3. Further Testing: Depending on your healthcare provider's assessment, further testing may be necessary. This could include blood tests for autoimmune markers, imaging studies, or even a repeat bone marrow biopsy if indicated.

4. Lifestyle Considerations: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and adequate sleep, can support your immune system and overall health.

In conclusion, recurrent fever can be a complex issue with various potential causes. It is essential to work closely with your healthcare provider to identify the underlying cause and develop an appropriate management plan. Your proactive approach to monitoring your health and seeking medical advice is crucial in addressing these recurrent episodes effectively.

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