Persistent Body Heat and Weakness Without Fever

Generalized warmth (without fever) and overall weakness?

Hello Doctor,
Patient: Female, 58 years old.
No fever but experiencing generalized warmth and weakness.

Medical History: The patient's temperature has fluctuated between 36°C and 37.5°C over the past two weeks, with higher readings during the day (37.2°C to 37.7°C).
The patient feels warmth radiating from the back of her head.
She has had low-grade fever (ear thermometer readings are 1°C to 1.3°C lower than mercury thermometer readings) for over a week.
The patient feels weak and has been coughing with sputum (deep yellow and sweet potato-colored sputum, both present, and the sputum is thick).
Prior to the onset of symptoms, she visited a department store.
Currently, the patient does not have a fever but still feels weak, although she feels much better than a few days ago.
However, she still feels physically weak.
Due to persistent coughing and fever over the past two weeks, she has lost her appetite and has lost 2 kg.

Additionally, the patient has been coughing since 1998 and has been seeing a pulmonologist at a veterans' hospital, but there has been little improvement.
(She had an X-ray a year ago that showed non-tuberculous mycobacteria, but the doctor said it was not serious, and the current X-ray shows no significant changes; she is currently undergoing bacterial culture.)
Previous evaluations suggested a possible adenovirus infection, but there was no sore throat or inflammation, and there was no significant improvement after medication (which has now been discontinued).
The patient still feels weak but is better than a few days ago.

Questions: Is this influenza? What can be done to help the patient feel better? Which specialist should she see? What could be the diagnosis?
Recent tests (X-ray and white blood cell count) showed no issues according to the doctor (tests were done last Thursday).

Request for assistance: What is the diagnosis, and which specialist should she consult?

Miss Yang, 20~29 year old female. Ask Date: 2011/07/23

Dr. Yang Wenda reply Pulmonology

Dear Ms.
Yang,
The patient has experienced coughing, yellow sputum, fever, and fatigue, which suggest a lower respiratory tract infection (involving the bronchi and lungs).
The chest X-ray shows no significant infiltrates, indicating that it may simply be a case of bronchiectasis exacerbated by infection.
The causative pathogens could be viral (thus antibiotics are not necessary) or bacterial, with culture reports indicating a 5% chance of not identifying any pathogens.
Other less common pathogens include Mycobacterium tuberculosis, non-tuberculous mycobacteria (which can easily colonize patients with bronchiectasis), or fungi (more likely in immunocompromised patients).
Antibiotics are only beneficial for bacterial infections.

I believe the patient is now in the recovery phase, with symptoms easing, but overall stamina may take several weeks to fully recover.
If coughing and sputum production persist, the patient can consult a pulmonologist for medications to alleviate symptoms.
It is advisable to reduce the intake of sweets and cold foods, as this may also help decrease coughing and sputum production.
Wishing you a speedy recovery!

Reply Date: 2011/07/23

More Info

Understanding persistent body heat and weakness without fever can be quite complex, especially in a 58-year-old female patient with a history of chronic cough and previous respiratory issues. The symptoms described—persistent body heat, weakness, and a productive cough with thick, discolored sputum—suggest a few potential underlying causes that need to be explored further.

Firstly, it is important to note that the sensation of heat without an actual fever can be attributed to several factors. The body's thermoregulation is controlled by the hypothalamus, which can sometimes misinterpret signals, leading to a feeling of warmth even when the core body temperature remains within normal limits. This can occur due to various reasons, including hormonal changes, particularly in women around menopause, or as a response to chronic illness.

The presence of a chronic cough and the production of thick, discolored sputum raises concerns about possible respiratory infections or chronic lung conditions. The fact that the patient has a history of non-tuberculous mycobacterial infection (NTM) and has been under the care of a pulmonologist suggests that her lungs may be more susceptible to infections or inflammation. The sputum's color and consistency indicate that there may be an ongoing infection or inflammation in the respiratory tract, which could explain the persistent symptoms.

Given the patient's history and current symptoms, it is crucial to consider the possibility of a respiratory infection, such as bronchitis or pneumonia, which can sometimes present with low-grade fever and systemic symptoms like weakness and malaise. Additionally, the patient's weight loss and decreased appetite are concerning and warrant further investigation to rule out more serious conditions, including malignancies or chronic infections.

In terms of management, it is essential for the patient to follow up with her healthcare provider, ideally a pulmonologist or an infectious disease specialist, who can conduct a thorough evaluation. This may include further imaging studies, such as a chest CT scan, and additional laboratory tests, including sputum cultures and possibly bronchoscopy, to obtain a clearer picture of her lung health.

In the meantime, supportive care is crucial. This includes ensuring adequate hydration, nutrition, and rest. If the patient is experiencing significant discomfort or difficulty breathing, she should seek immediate medical attention. Symptomatic treatment for cough and any associated discomfort may also be beneficial, but this should be guided by a healthcare professional.

In summary, while the patient's symptoms of persistent body heat and weakness without fever can be attributed to various factors, the combination of chronic cough, sputum production, and weight loss necessitates a comprehensive evaluation by a specialist. Early intervention and appropriate management are key to improving her overall health and addressing the underlying causes of her symptoms.

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