Ask a doctor on the topic of Internal medicine

Recurring fever every day for several weeks.

December 2, 2021 | 40,00 EUR | answered by Dr. med. Ralf Berg

Good evening from Bulgaria,
my concern is about my wife. In September, she had a virus-like infection (Covid 19 was ruled out as several tests were negative), she had body aches, fever a few times, mild cough, and slightly swollen lymph nodes. Two weeks later, her eyes became inflamed, so we visited an ophthalmologist who diagnosed keratitis and prescribed drops.
Since October 19th, she has had slight fever every afternoon, between 37 and 37.7 degrees, which disappears on its own each time, she does not take any fever-reducing medication. However, she has now experienced the following symptoms again: a stuffy nose, mild sore throat, and occasional shortness of breath. A lung X-ray was taken, which showed no abnormalities. Due to the shortness of breath, we also consulted a cardiologist, a Holter monitor was done, and an arrhythmia was detected, and Dipyridamole and Rytmonorm were prescribed. Unfortunately, the fever persists, returning every day, every afternoon into the evening.
Blood tests were also done and all values were normal (including thyroid, liver values, CRP protein, high sensitive CRP, sugar, cholesterol, creatinine, etc.), urine was also examined, which was normal. The laboratory results are attached here.
Unfortunately, no one in Bulgaria has been able to provide any guidance or help so far. We would like to know what else needs to be investigated in order to reach a diagnosis.
I am hoping for help through this channel.
Thank you in advance.

Dr. med. Ralf Berg

First of all: The question of diagnosis is difficult, as it concerns individual symptoms that do not easily fit into a specific disease entity. However, there are still some things that could and should be further examined, and I can provide you with some information on that:

1. It is possible that somewhere in the body there is a source of inflammation/abscess or a so-called focus, which is responsible for the fevers. The roots of the teeth, which are often responsible for chronic inflammation (root granuloma), have not been examined yet. (X-ray of lower and upper jaw at the dentist, search for focus)
2. Further investigations should be done to identify diseases from the rheumatic spectrum. Laboratory tests: RF, Anca, AST antigen, citrulline. I am not sure if you can easily get these in Bulgaria. It should be possible with a rheumatologist.
3. Foci could also be present in the sinuses. This would only be further investigated through an MRI of the skull. Alternatively, ask the ENT doctor to examine if there are any inflammation foci in his area of work.

I hope this provides you with some guidance.

Kind regards, R. Berg