Brief Answer: Do evaluation for fever of unknown origin Detailed Answer: Hello, Thanks for posting on XXXXXXX I am so sorry for the troubles you have encountered. Personally, I doubt if your doctor does not know what to do but he might rather be faced with a fever of unknown origin (FUO). FUOs are caused by infections (30-40%), neoplasms (20-30%), collagen vascular diseases (10-20%), and numerous miscellaneous diseases (15-20%). The literature also reveals that between 5 and 15% of FUO cases defy diagnosis, despite exhaustive studies (Reference: WWW.WWWW.WW . The following conditions are sources of FUO: - Abscesses: Usually is accompanied by a localized pain (where ever the abscess is located in your body) - Tuberculosis: often presents with high grade fever and night sweats especially if pulmonary. TB of other organs may present with just fever. - Urinary tract infections: Urine test may show normal, but the infection might still be present - Endocarditis: Can be missed if a cardiac exams was not carefully performed by your doctor to detect heart murmurs - Hepatobiliary infections: which require evaluation of the liver and gallbladder - Osteomyelitis - Chlamydia - Systemic bacterial illnesses or sepsis: requires blood culture. Also other systemic viral and parasitic diseases need to be ruled out especially if you are found in an endemic zone e.g test for malaria which I doubt you have that given you are located in the USA. Others such as enteric fever, enterocolitis etc - HIV/Acquired immunodeficiency syndrome (AIDS) - Herpes viruses - Fungal infections - Parasitic infections - Lymphomas: Presence of lymph nodes significantly increase chances of this condition - Leukemias - Solid tumors: Pain usually is present - Malignant histiocytosis - Collagen vascular and autoimmune diseases: There are good number and your doctor should be able to consider this then go ahead to running diagnostic tests. - Endocrine disorders - Factitious fever - Rheumatic diseases - Premenopausal syndrome: can present with pseudofever (false fever) which might trick some practitioners if not put into consideration. - Pelvic inflammatory diseases (PID): often accompanied by pelvic pain. In your situations, I will start by evaluating first the most likely (I will be guided by the results of patient's physical exams and other findings after conducting general laboratory tests. Note that, FUOs can be problematic in determining the cause, but with a little bit of patience from your health care providers and from yourself, the cause should able to be sorted out. Tests to rule out the most likely possibilities include laboratory work-ups and Ct scan. If all the tests run turn out clear, then I suggest you to be referred to a gynecologist (for a start), then to an internist who can better assimilate all symptoms, signs, laboratory and imagery findings then reach to a definite conclusion. Hope this helps and wish you the best. Dr. Nsah

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