Patient :The patient is Female, 50yrs old.
She was diagnosed with Cervical Spondylitis and Frozen shoulder, around 2 years back, we did physiotherapy and some anti-inflammant medications. As that wasn’t helping, we went for alternate medicine (Ayurvedic hot oil massage and physical traction, with some herbal medicines) - and this is still ongoing with little benefit (there is some benefit, but very less)
She started getting Gastro-ulcer, for which herbal medicines were prescribed by the Ayurvedic doctor, and there was relief to an extent.
Slowly she started getting mouth-ulcers on the inside of her mouth, and burning sensation in the mouth on eating any kind of spices. Nothing was really done for this, and was suspected an extension of the stomach ulcers.
Around 6 weeks ago, she started getting high fever and chills every evening 6/7pm onwards till morning. Our family doctor suspected a urinary tract infection, and recommended a Urologist, so we did a urine test and it had high amount of pus cells, for which the urologist gave antibiotic injections and tablets.
The urologist also recommended to do Liver Function Test (LFT III), which we did, results are attached.
After the antibiotics, the evening fever subsided, and she started getting all-day fever every day (3 weeks now).
During the treatment of urologist, she had excessive mouth pain (nervous - more on the right side) and slight blood in her cough. It was suspected as part of stomach ulcers, but a Ear-Nost-Throat (ENT) specialist was recommended.
The ENT specialist said that the upper jaw had an infection due to less space for the tooth, and gave antibiotics to treat that, the nervous mouth pain has subsided after that and there has not been any kind of bleeding since.
For the fever, the ENT suspected typhoid fever, and suggested a Widal test. The test was found negative, she does not have typhoid fever.
In one of the test results, the ESR = 44, which is considered high, and hence there is some infection or inflation somewhere, unidentified.
The urologist also asked to do an ultrasound, in which there were some abnormalities (results are attached), and hence he recommended to consult a Gynecologist.
The Gynecologist concluded that no treatment is needed despite multiple fibroids, as it could go away after menopause phase (which is due).
The current situation is: Fever is still present throughout and does not subside with Panadol, loss of appetite, nausea-feeling, mouth ulcers are still present, fever is still present. There is no diagnosis yet for the prolonged fever (around 6 weeks now).
All attachments: http://ritenv.com/jyoti-test-reports.zip
Symptoms: Prolonged fever, nausea, loss of appetite, general weakness, pain in random body areas
Hello. Welcome to Ask The Doctor. We are here to help you.
I have read your query in detail and have studied the all reports.
First of all she never had any Urinary Tract Infections as per her urine report.
Moreover, persistent fever even after the many course of different antibiotics from different doctors represents that probably there is no bacterial Infection.
Looking at the history and high ESR I would recommend evaluating for following diseases:
1. Rheumatoid arthritis
2. Systemic Lupus Erythematosus (SLE)
I would advice following tests for this purpose:
1. R-Factor, Anti CCP Antibody.
3. Chest Xray
4. Fasting blood sugar.
5. Thyroid function tests.
The diagnosis of her fever and all the presenting symptoms you would get in these investigations.
Stop treating her with antibiotics.
Probably she has some Autoimmune disease.
You should see an Internal Medicine Specialist (MD Medicine) for this purpose and share my opinion.
He would agree to my opinion and would get her the above-mentioned tests done.
I hope it helps you.
If you have any further query, please ask me.
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