My fever didn't reach 103, so I'm not hot-blooded.

October 21, 2008 9:08 PM

Fatigue and low-grade fever for three weeks but no other symptoms. Why is my doctor so freaked out, and what is he testing for?

I went to the doctor today for a routine thyroid function test and happened to mention that I've been feeling run-down, exhausted, and have had a low grade (99.4-100.4) fever more days than not for the past three weeks. There was an immediate switch in his normally calm demeanor as he asked a bunch of follow-up questions about other symptoms (none) and timing and such.

He told me he suspects a viral infection, and ordered a chest x-ray and a test for Epstein-Barr (mono). He first told me to come in on Monday for a follow up, and then changed his mind to Friday, and said that the office would work around my schedule to make sure I was seen.

The phlebotomist did 2 cultures - one she said was for mono - and took 6 vials of blood - one is a CBC and another for the thyroid test. She was vague when I asked about the other tests, and the doctor was with his next patient so I couldn't ask him. What might he be testing for?

posted by anonymous to health & fitness (18 comments total)

I don't want you to panic, but from Wikipedia: Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. I'm guessing this is why they didn't want to say anything much.
posted by 0xFCAF at 9:27 PM on October 21, 2008

Sorry, that should have been: plugging in moderate fever to WebMD's symptom checker comes up with many candidate illnesses, including viral pneumonia.
posted by zippy at 9:36 PM on October 21, 2008

They take 4-6 vials of blood whenever I get tested for anything, even in good health. SO that itself may not mean anything.
posted by GuyZero at 9:38 PM on October 21, 2008

Any fever that lasts a long time is a source of concern. It means the immune system is trying to fight something, and it isn't winning.

One time I had "walking pneumonia" and I had a fever for two months, before my doctor finally gave me the right antibiotic (Levaquin) to fight it.
posted by Class Goat at 9:40 PM on October 21, 2008

While we're trying to scare the crap out of you, another thing that can cause a long-term fever is leukemia.
posted by Class Goat at 9:44 PM on October 21, 2008 [1 favorite]

Fevers of Unknown Origin, as your case is typically called, are always hard to diagnose quickly. Do a google search for FUO and it'll bring up some articles.

The majority of FUO cases are due to infection. But in adults, there is the chance that your fever could be due to malignancies (like cancers) or autoimmune disorders (like lupus)

Most of the time it is an infection, and if it is, most of the time that infection is mononucleosis.

If you've traveled, your doctor will also check for less common diseases (ie, typhoid fever, tuberculosis, malaria, ehrlichiosis, Lyme disease, blastomycosis, tularemia, histoplasmosis, cat-scratch disease, brucellosis, leptospirosis, salmonellosis, tularemia, visceral larva migrans, and toxoplasmosis)

Urinary tract infections, sinusitis, mastoiditis, or central nervous system infections are some common diseases presenting as FUO.

Honestly, nobody here can tell you what to expect. Basically your body has been rallying it's resources like crazy for the last few weeks fighting *something*. It could be anything.

I know it's scary when you're presented with the unknown, but your doctor is on the right track. Testing for the easiest and most common things is the best way to start. If they don't find a common virus, be prepared for more tests until he figures it out. This isn't one of those things where they'll just say "oh well"

Do be aware, however, that around 10% of FUO's are never figured out and just go away, most likely due to a virus that the body eventually fought off and the doctors just couldn't detect it. Lots of things are still a mystery.
posted by lockle at 9:47 PM on October 21, 2008 [4 favorites]

Lockle's answer is spot on; they do need to err on the side of caution and test for all possibilities.

For my boss, her FUO turned out to be a urinary tract infection with no other symptoms. For me, it turned out I had Babesiosis .
posted by gudrun at 10:41 PM on October 21, 2008

I had symptoms similar to yours. These symptoms went on for months. After many blood test and scans a definite diagnosis was made, cytomegalovirus. My Dr was very concerned while trying to figure out what was wrong with me.

Dr. said diagnosing this was a case of "hearing hoof beats and it turns out to be a zebra".
posted by JujuB at 10:43 PM on October 21, 2008

A.) It's serious, you're going to die, you should be freaking out right now.

B.) It's just an infection, you'll be fine and live to a ripe old age.

Since B is more likely than A, and you can't know either right now anyway, the safest bet is to just take it easy, try and relax and be happy that you have a doctor who is on the ball about finding an answer for you symptoms. You're probably fine.

But please contact the mods, and let them post a follow up so we can get some closure....
posted by wfrgms at 10:56 PM on October 21, 2008

I had a couple of bouts of ongoing low-level fever; both times turned out to be related to autoimmune flare-ups. It took a while to figure out what was going on, and I felt like shit and was freaked out, but everything ultimately turned out fine. Try not to work yourself up too much -- I know, an impossible task, right? -- and just keep in mind that your doc is simply exercising due diligence to rule anything in or out. (And they take several vials of blood whenever I go in, too, just for my routine thyroid tests. So don't read too much into that.)

Take care of yourself -- get enough rest and try not to stress. I hope you have some answers soon.
posted by scody at 11:38 PM on October 21, 2008

Most likely the doctor was being vague so as not to worry you - which will not do you any good, even if you do have something like aids or leukemia, worrying about isn't going to make it any better. Wait til Friday and don't think about it until then. Unnecessary stress is only going to make your symptoms worse.
posted by missmagenta at 1:26 AM on October 22, 2008

What might he be testing for?

A better way to think of this is as a scientific approach to ruling out a variety of causes.
posted by dhartung at 1:26 AM on October 22, 2008

now you have me worried about you too, so yes, kindly provide closure
posted by NekulturnY at 4:28 AM on October 22, 2008

B-symptoms and Pel-Ebstein tend to get physician's hackles up (if they're good).
posted by i_am_a_Jedi at 4:51 AM on October 22, 2008

You don't mention your age but if you are an adult that sounds very much like mono. Mono in adults is very different than mono in kids. In adults it can be a low grade fever and/or mild body ache that can take several months to clear up. It doesn't knock you out like it did when you were 12, it just makes you feel like crap for months. As mentioned above, it could also be 1000 other things, which is why they run so many tests.
posted by COD at 5:36 AM on October 22, 2008

Ditto on the immune system thing. When I was a teenager I had similar symptoms, which my family and decided was just depression but eventually we figured out it was septicemia (toxic shock) from a tooth I'd broken 5 years before. Unfortunately that was only figured out when I was unsettlingly close to dead, so good on your MD for taking it seriously now.

Oh- and somewhere in there I had mono, or at least ended up with the anti-bodies to it. Who knows where that fit in.
posted by small_ruminant at 8:47 AM on October 22, 2008

"I'm going to say I don't want you to freak out, but I can't resist this opportunity to point out my nebulous medical knowledge that your symptoms may indicate that you have AIDS OR CANCER!!!"

Just relax until your doctor tells you to worry. You probably aren't seriously ailing with a hideous disease. If you are, deal with it then. He mentioned mono, so perhaps mono really is what he thinks is the problem. Mono isn't overwhemlingly terrible, but it's good to know you have it -- so you can take care of your swollen-ass spleen.

Something similar happened to me in college, and the doctor took a staggering amount of my blood away for testing, and I had a urinary tract infection. Asymptomatic besides the low-grade fever -- but a UTI all the same. And I'd also just had mono, so I was still a little wiped out from that. I'm just saying, don't melt down, and don't let pseudomedical dire predictions get to you.
posted by Coatlicue at 12:49 PM on October 22, 2008 [1 favorite]

I talk to people who have medical concerns about their generalized symptoms (like fatigue, etc.) a lot. We tell them that while there's always the possibility that it could be something serious, like cancer, it is usually not, and is more often an infection of some sort.
posted by fructose at 7:08 PM on October 22, 2008