Unexplained Aches and Fever: Seeking Medical Guidance

Unexplained muscle soreness?

Hello, Dr.
Lin.
I have been experiencing acute pharyngitis since mid-April and saw an ENT specialist.
After taking medication, my symptoms improved.
However, I later developed a fever of 39.5 degrees Celsius and consulted an internist, which also led to some improvement.
Currently, around 5 PM, I experience intermittent fever with a temperature ranging from 37.5 to 37.8 degrees Celsius, along with severe headaches, dizziness, and generalized body aches, particularly in my limbs and lower back.
I have seen an internist, but no cause has been identified.
After taking a hot shower, I noticed distinct red spots on my legs.
These symptoms have persisted for over 12 days.
How should I seek medical assistance, as I am unsure which specialty to consult? Thank you for your help.

Xiao Su, 40~49 year old female. Ask Date: 2009/05/19

Dr. Lin Mingfeng reply Internal Medicine

Your description indicates that there was a preceding upper respiratory infection, followed by low-grade fever and an unexplained rash.
Regarding the issue at hand, it is unclear whether you are still experiencing a fever.
If you are still febrile (with an afternoon temperature above 37.8°C), please consult an infectious disease specialist to investigate the cause of the fever of unknown origin.
If there is no fever, please first see a dermatologist to determine the cause of the rash.

Reply Date: 2009/05/19

More Info

It sounds like you are experiencing a complex set of symptoms that have persisted for over 12 days, including unexplained fever, body aches, and specific skin changes. Given your history of acute pharyngitis and the subsequent development of these symptoms, it is crucial to approach this situation methodically.

Firstly, the fever you are experiencing, particularly the spike to 39.5 degrees Celsius, suggests that your body is responding to some form of infection or inflammatory process. The fact that you have seen an ENT specialist and an internal medicine doctor without a clear diagnosis indicates that further investigation is necessary. The presence of red spots on your legs after a hot shower could be indicative of several conditions, including an allergic reaction, a vascular issue, or even a dermatological condition that warrants further examination.

Given the duration and severity of your symptoms, it is advisable to seek a more comprehensive evaluation. Here are some steps you can take:
1. Follow-Up with a Specialist: Since your symptoms are systemic (fever, body aches) and localized (red spots on the legs), it may be beneficial to consult a rheumatologist. They specialize in autoimmune diseases and systemic conditions that could explain your symptoms. Conditions such as vasculitis, which can cause skin changes and systemic symptoms, might be considered.

2. Infectious Disease Consultation: If your symptoms are suggestive of an infectious process that has not been identified, an infectious disease specialist could provide insights. They might recommend specific blood tests, imaging studies, or cultures to identify any underlying infections that may not have been detected in previous evaluations.

3. Comprehensive Blood Work: Ensure that you have had a complete blood count (CBC), inflammatory markers (like ESR or CRP), and possibly specific tests for autoimmune diseases (like ANA or rheumatoid factor). These tests can help identify underlying conditions that may not be immediately apparent.

4. Monitor Symptoms: Keep a detailed log of your symptoms, including the timing of fever spikes, any associated symptoms (like headaches or skin changes), and any treatments you have tried. This information can be invaluable for your healthcare providers in making a diagnosis.

5. Consider a Dermatological Evaluation: Since you have noted specific skin changes (red spots), a dermatologist may be able to assess these lesions and determine if they are related to your systemic symptoms or if they represent a separate issue.

6. Emergency Care: If at any point your symptoms worsen significantly, such as experiencing difficulty breathing, severe headache, confusion, or if the red spots spread or change in appearance, seek emergency medical care immediately.

In summary, your symptoms warrant a thorough evaluation to rule out serious conditions. It is essential to communicate openly with your healthcare providers about the persistence and severity of your symptoms. They can guide you through the necessary steps to obtain a diagnosis and appropriate treatment. Remember, your health is paramount, and seeking further medical advice is a proactive step towards understanding and addressing your condition.

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