Constant high fever and joint pain
September 16, 2010 | 15,00 EUR | answered by Dr. med. Ralf Berg
Hello, I have the following problem: at the end of July, I had high fever for over 3 weeks, up to 40.7. At first, I only had the fever and was given antibiotics, but saw no improvement. Then I started experiencing pain in my knee joints. Blood was taken and my ASL value was over 600, so I was given antibiotics again. The fever eventually went down and disappeared, but the joint pain remains in my knees, foot, and hip. For the past two days, I have had high fever again, up to 40.5, and I don't know what to do anymore. My doctor says he can't help me and doesn't know what to do next. No further tests have been conducted. I am 30 years old and otherwise healthy. Thank you.
Dear Questioner,
In your case, further investigations are definitely necessary to get to the bottom of the cause. First, it would need to be clarified whether you have been in tropical countries or had contact with people from these countries to include infectious tropical diseases (malaria, relapsing fever, etc.) in the list of possible causes to be excluded. If this applies to you, you should be referred to a doctor specialized in this field, or contact one of the two tropical medicine institutes in Germany (Hamburg: Bernhard Nocht Institute, or University of Tübingen Tropical Medicine Institute).
If not, there are other things that need to be clarified. If you live in an area (Southern Germany) where Lyme disease is transmitted by ticks (or were there on vacation), blood tests related to this should be conducted. The very high fever spikes with joint involvement also suggest a septic event, where there may be an abscess/pus focus somewhere in your body and these bacteria occasionally enter the blood. Therefore, for example, an internist should at least perform an ultrasound examination of the abdominal organs (liver, spleen, kidneys). The painful joints should also be further investigated with X-ray/MRI, possibly leading to arthroscopy. Additionally, further blood tests should be done to rule out any rheumatic conditions (RF, ANCA). It is very important for confirming an infectious cause that blood cultures are taken if you experience another fever spike. There is a lot to do. Please discuss these suggestions with your doctor and ask him to refer you to colleagues who can perform the tests mentioned here if he cannot do so himself. Given the few clues, I cannot tell you exactly where to start the search. I would first look for an abscess/focus. It is important that further clarifications are definitely initiated. (I understood correctly, it was just high fever and joint pain, no typical cold symptoms like coughing, runny nose, etc., right?)
Best regards, R. Berg
