Persistent Fever for 19 Days: Symptoms and Next Steps - Internal Medicine

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Persistent fever lasting for 19 days, especially when accompanied by a variety of symptoms such as sore throat, joint pain, chest tightness, palpitations, diarrhea, and mouth sores, is a concerning clinical scenario that warrants careful evaluation. Given that you have undergone extensive testing, including blood tests for white blood cell count (WBC), C-reactive protein (CRP), and other relevant markers, which have returned normal, it suggests that there may not be an acute infectious process at play. However, the persistence of fever and the emergence of additional symptoms indicate that further investigation is necessary.

In your case, the normal results from the infectious disease specialist and rheumatology consultations, along with the normal EKG and chest X-ray, provide some reassurance that there is no immediate life-threatening condition. However, the presence of symptoms such as chest tightness and palpitations, especially when associated with high blood pressure readings (185/100), should not be overlooked. These symptoms could indicate a potential cardiovascular response to stress or illness, and they may require further evaluation.

The use of corticosteroids, as prescribed by your rheumatologist, can be beneficial in managing inflammatory responses, but it is essential to weigh the risks and benefits. Corticosteroids can help reduce inflammation and may alleviate some of your symptoms, but they can also suppress the immune system, which might not be ideal if there is an underlying infection that has not yet been identified. It is crucial to have a discussion with your healthcare provider regarding the use of these medications, especially considering your ongoing symptoms and the uncertainty surrounding your diagnosis.

Regarding hospitalization, the decision should be based on the severity of your symptoms and the potential for further deterioration. If you experience worsening symptoms, such as increased difficulty breathing, persistent high fever, or significant changes in your blood pressure, it would be prudent to seek immediate medical attention. Hospitalization may be necessary for close monitoring, additional diagnostic testing, and potentially intravenous medications or fluids.

In the meantime, there are several steps you can take to manage your symptoms and support your recovery:
1. Stay Hydrated: Ensure you are drinking plenty of fluids to stay hydrated, especially if you are experiencing diarrhea or fever.

2. Rest: Allow your body to rest and recover. Avoid strenuous activities that could exacerbate your symptoms.

3. Monitor Symptoms: Keep a detailed record of your symptoms, including fever patterns, blood pressure readings, and any new symptoms that arise. This information can be valuable for your healthcare provider.

4. Follow-Up Appointments: Attend any follow-up appointments with your rheumatologist or primary care physician to discuss your ongoing symptoms and any new test results.

5. Seek Immediate Care if Necessary: If you experience any alarming symptoms, such as severe chest pain, difficulty breathing, or significant changes in your mental status, do not hesitate to seek emergency care.

In conclusion, while the normal test results provide some reassurance, the persistence of your fever and the array of symptoms you are experiencing necessitate ongoing evaluation. Engaging in open communication with your healthcare providers about your concerns and treatment options is essential. They can help guide you through this complex situation and determine the best course of action for your health.