Fever, cough, night sweats: What could I have?

Dear Ask The Doctor:  Hello, Three weeks ago, I travelled to India, upon arriving in India, I had an extreme fever, and had pain on my lower right side and extreme pain just to the right of my spine on the right side of my back (in the middle chest area). The pain was so severe that I could not inhale more than 10-15% of my lung capacatiy without feeling like someone was hitting a pressure point in my back. I called a doctor and he gave me a anti inflammitory in shot in the bum that took away the pain in the back and left it only on the right side. He also prescribed an antibiotic (cipla) which contains orinidazole IP 500mg and Ofloxacin IP 200mg for 5 days. I had diahrea for a week, and severe night sweats. I also woke up one morning with a bloody nose (I have never had a bloody nose in my life). After this first week I lost 11 lbs. After flying home, I visited a doctor and ahd a chest xray done. They ruled out tuberculosis from the chest xray, and prescribed 500mg of Levofloxacine for 5 days and broncophane cough medicine and something to break apart my phlegm in the chest. The night sweats dissapeared. In week 3, I the night sweats have returned, and the cough will be non existant if I am not speaking or moving around. However at times if I am talking I will have a coughing fit where it sometimes leads to puking. Once the puking happens the airway is clear and I do not puke anymore. The sickness does no happen everyday and appears to only happen when I can not clear the airway. I have also began to notice tiny amounts of blood in my phlegm in the first morning spit, and none afterwards. I have returned to the doctor and he has taken a blood test for Typhoid fever, tuberculosis (although I have been tested for this numerous times in the past few years as I work in a public sector), and 2 other illnesses I had never heard of. The pain in my right side is not as severe as it used to be, but I still notice it if I attempt to take a full breath, it is at the lower right side of the rib cage and slightly below. My weight has varied at times, the lowest I have weighed was around 168lbs (down from 185). This was in the morning extremely dehydrated after night sweats. I now consistently weight between 172-176 depending on my hydration level. I also have the energy to lift weights, and despite my weight loss I am still lifting similar amounts of weight. 1. Diagnosis? 2. What are the chances I could have tuberculosis if I had a clear chest xray a week into the infection? 3. I also live in the middle east and it is sand storm season as this may be prolonging my recovery. -Thank you,
 

Dear Patient:  You could have had an acute severe pneumonia or a kideny infection from what symptoms you have described early on. However the night sweats and weight loss does make one think about TB and thus it is good that you are checked up for the same. Moreover since you visited India and had fever with night sweats one may also suspect malaria which will manifest with similar symptoms. If you indeed have had TB then the chest xray would have shown it since you had respiratory symptoms. You can also get a TB skin test done. I am not aware of how a sand storm season can definately affect your recovery but it sure can make you more susceptible to dust and prolongation of upper respiratory tract symptoms like cough and runny nose. All the best.

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