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Suggest Treatment For Persistent Fever And Body Pain

Posted on Fri, 19 Aug 2016

Question: I've had a fever for the past 2 1/2 weeks off and on. Just a couple of days ago I've started to have a rash on my limbs and on the bottoms of my feet. I've seen a practitioner and they told me to go home and rest. I have severe pain in my wrists and ankles and can't work. The pain in my wrists and ankles didn't start at the same time. It started with my left elbow and radiated to my left wrist. The pain began as though I had hit my funny bone and had a bruise there, but I couldn't recall hitting it on anything. That wrist has gotten better but I have pain in my right one now. My left ankle has begun to hurt today as though I twisted or sprained it but I haven't had any injuries. I don't know what to do but this has lasted too long.

Answered by Dr. Naval Mendiratta (4 hours later)

Brief Answer:
VIral fever

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well, the symptoms of fever, rash and migratory arthritis( one joint at one time and then spreads to involve the next), does need to be investigated...I would like to ask you a few more queries..Cause we should start treatment before it progresses further...

1. If you could attach the picture of the rash here, that would be helpful...Rashes do give us a clue on what disease it could possible be...

2. DId you have any recent history of travel??

3. Any history of loose stools or burning micturtion prior to the start of these symptoms??

4. Do you have any oral ulcers/hair fall/dry eyes or dry mouth

5.. DId your GP examine the joints??CAuse if active swelling is there, we should treat it asap

ONe of the common diseases in your country is Lyme disease..It is usually caused by tick bite and can cause constellation of these symptoms--> Fever, rash and migratory arthritis... Other possibility is REactive arthritis which can happen after an infective episode( Like urinary tract infection or gastroenteriti)..SO we need to go further and get it investigated

Do let me know these queries. If you could attach a picture of the rash , it would be helpful

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Naval Mendiratta (1 hour later)

Thank you Dr. Naval. Bloodwork is negative on the Lyme disease. I dont have any unusual gastro symptom. No pain. Bowel movements are regular. Im attaching photos. Thank you.

Answered by Dr. Naval Mendiratta (15 hours later)

Brief Answer:
Is it connective tisssue disease or vasculitis

Detailed Answer:
Good evening

Sorry for the delayed reply. Had a long duty today

I have gone through your pictures and the rashes do point towards Erythrema nodusum ones..The ones on your sole of foot look like vasculitic one.

The fever, arthritis and rashes do point towards a systemic illness.. I would like to put forward a few differentials and the approach in your case...

1. Viral fever: ANy viral infection can cause these sort of reactions along with joint pains and fever...For that we need to wait and watch..But the only thing which is against is the duration it has lasted for..Viral never lasts for more than 5-7 days..But this has been going on for long..So I wont favor this diagnosis

2. Start of a connective tissue disease/Vasculitis: These symptoms could go more in favor of a connective tissue disease like Lupus..But the duration is a bit 2 early to label it...Never the less, a Biopsy of these rashes will give us a conclusion on what we are dealing with..Is it ERthyrema nodusum( fat inflammation ) or vessel inflammation( Vasculitis)

3. Post viral syndrome

I wont suggest you wait any longer since these are persisting for more than 2 weeks. Moreoever these rashes wont fade away without suppressing them. I would suggest you a few tests, which if you could get done would be useful

1. Complete Blood count, ESR, and C Reactive protein
2. Urine routine
3. X Ray Chest
4. Liver function tests
5. ANA
6. A Skin biopsy of the lesions would be of utmost help as it will point us towards the diagnosis and how strong of a treatment you need

As for the treatment, start on anti inflammatory drugs..( provided you dont have any allergy to any medicines)

Naprosyn 500 mg twice daily for 5 days would be helpful...You may need a short course of steroids but after the results are done..

Hope the information was useful

Do let me know for more queries

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (2 hours later)

I don't have any history of those things. What sort of diseases could that be?

Answered by Dr. Naval Mendiratta (17 hours later)

Brief Answer:
Further course

Detailed Answer:
good evening

well as per your history it does sound like an autoimmune problem which may have been triggered by viral infection . The conditions I have mentioned are autoimmune. The tests I have advised are to determine what exactly it is. It can be self limiting at times or can get prolonged.. So that we will know from the investigations. Your doctors are waiting to see if it resolves itself..

Do if you can get the investigations done it will be helpful to determine the exact reason behind your problem..

hope the information was useful..

do let me know for more queries. would be happy to help out

regards
Dr naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (4 days later)

Dear Dr. Naval,

I have gone to hospital and bloodwork, x-rays, and pelvic exam have not given a diagnosis of any kind of auto-immune problem. I had a very high fever today after not having one for a few days. I now have a painful rash on the palms of my hands.

Answered by Dr. Naval Mendiratta (14 hours later)

Brief Answer:
Fever with rash

Detailed Answer:
Good evening

Thanks for your reply

I have gone through your pictures. These rashes are definitely not an infective ones...And I am not sure why they are not evaluating it further...

The blood work they have performed..CAn you tell me the exact work they have carried out??CAuse we are bound to miss the diagnosis if we dont perform the specific test needed...Moreoever the rashes are so specific for vasculitis...A Biopsy will help us determine it...

The type of illness you are having is waxing and waning types..It may evolve over time...But there still hasnt been any treatment to resolve it. ...I would recommend you schedule an appointment with a rheumatologist there and start working on the diagnosis..

Secondly, I would like to see a 2 D Echo of the heart as well..As the infection lying there is another cause of fever joint pains and rashes..That is another diagnosis which we can miss..

What is your doctors take on seeing the rashes???

DO let me know these queries. I dont wanna delay the diagnosis when it can be caught earlier

Await your reply

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (12 hours later)

Hello Dr. Naval,
I am back in hospital and theyve run more tests. I will attach the results theyve given me. I awoke to swollen lyph nodes on my throat and neck and horrible body aches.My rash has spread to my torso and is very painful on my hands. Thank you for your help.
Thank you, XXXXXXX

Answered by Dr. Naval Mendiratta (21 hours later)

Brief Answer:
Further Course

Detailed Answer:
Good evening

I have gone through your results. Only abnormality I could find was raised CRP and Trace blood in urine...( I am not sure if it was done when your menses was going on), but the blood in urine is definately not normal

We need to run your ANA and XXXXXXX test.. Rash with arthritis and swollen lymph nodes does point towards an autoimmune disease..If they are negative, we are at least sure it is nothing 2 alarming..

Keep me posted on what they say...

Regards
Dr Naval

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar