Suggest Treatment For Severe Fatigue, Sore Throat And Cough

Posted on Mon, 11 Jul 2016

Question: Over the last 3 1/2 weeks my 16 yr old son has been having symptoms of an unusual high amount of fatigue and generally not feeling good. Then 3 days after it started he experienced sore throat and then coughing (dry). Took him in to see PCP on a Monday- she checked his breathing and throat. She did a strep throat culture - immediate results were negative. He did not have a temp. but often looked flushed in the face. She had lab grow the culture for a couple of days - came back negative. He was out of school that entire week. I called them on Thursday of that week to find out strep culture was negative and asked them to run more tests as he was getting sicker. They ran a mononucleosis test, a lyme disease test, a Vitamin D test and I believe a general look at white cells, red blood cells. The mono and Lyme test came back negative. His Vitamin D level was ok. Then he started to have runny nose and sinus issues - went thru about 4 boxes of tissues. Doctor gave him a "Z pack" antibiotic ( 5 days) but my son did not take the antibiotic on consecutive days - he should have been done with them and he has 1 pill left. Still had fatigue. Then on last Friday we put him on Allergy medicine - Claritin. Today I picked him up from school and he looked flushed in his face and said he had been dizzy at school - especially the entire last period. His eyes look a bit watery. He is exhausted and has a headache.

Previously He also had a high level of fatigue from Nov thru mid March. His doctor saw him at annual check and suggested he start taking Vit D in a tiered dosage - high level for 2 weeks, then bring it down for 2 weeks then bring it down again 2 weeks after that. Because there wasn't a big change in his energy level I calle dthe doctor - they ran a mono test and the results showed the antibodies were in line with being towards the end of mono and the Dr. said he could have had it for the last 6 mos.
What do you think?

Answered by Dr. Bonnie Berger-Durnbaugh (38 minutes later)

Brief Answer:
Some thoughts

Detailed Answer:
Hello and welcome,

I am not sure at what point he was diagnosed with Mono (Epstein Barr virus). Mono can definitely give prolonged symptoms of fatigue, headaches, and just feeling poorly. And the immune system can be mildly compromised from it and so a person may be more likely to get other viral infections concurrently.

I do not think Vitamin D level has much to do with any of his symptoms.

But I would suggest a TSH (thyroid stimulating hormone) and thyroxine level as sometimes after a viral infection a teen can get a transient thyroiditis which can cause fatigue too.

He should also have an Epstein Barr antibody panel which should include IgG and IgM levels. Elevated levels of IgM means that he still has an acute in infection to EBV; IgG on the other hand shows immunity from a past infection.

And his liver and spleen sizes should be checked with a physical exam to make sure they are not enlarged from the EBV. If there is any question about that, a liver function panel would be important to do too.

I hope this helps. This must be very frustrating.

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

Follow up: Dr. Bonnie Berger-Durnbaugh (2 days later)

The mono test was done in late March/early April and the results showed he apparently had the antibodies that suggested he was towards the end of Epstein Barr virus. He had experienced fatigue since December and his doctor said he could have had it for that length of time (5 mos.) . Another doctor in the same practice said mono only lasts for 1 month. Not sure who to believe.
I will check with the doctor's office re: thyroid test (transient). But I thought his thyroid was checked at the same time as the mono test.
Over the last two weeks there has been a lot of pollen in the air. We put him on Claritin (possible allergies) over the weekend and on Monday he complained about feeling dizzy while at school. His eyes looked very different.
Should he go thru a comprehensive allergy testing?

Answered by Dr. Bonnie Berger-Durnbaugh (27 minutes later)

Brief Answer:
About EBV

Detailed Answer:
Regarding the duration of EBV infection symptoms, it definitely varies. The majority of the adult population has had EBV infection. Most people have had EBV by the time they are in their mid twenties, and never knew they had it. Just a bad cold that lasts for a week to 1 month. However, there is a smaller subset that gets full blown Mono, and the fatigue from that can go on for months. In mono, the liver and spleen can also become enlarged in some people (which can be felt during physical exam of the abdomen) too, but this resolves in a shorter amount of time compared with the fatigue some get.

About the possible allergies: In much of the country right now (June), the seasonal allergen is grass pollen. It goes on for most of XXXXXXX The stuff you actually see blowing around, such as from Cottonwood trees, is for the most part too large to cause respiratory allergies. The pollen that causes itchy eyes, nose, throat, and sneezing is too small to see. If your son thinks the dizziness correlates with starting Claritin, you might want to switch to Zyrtec. If the eyes are very troublesome, there are antihistamine eye drops (by prescription).

Regarding getting comprehensive allergy skin testing, if the problem has been one that you have seen over time, rather than one that just started this year, then yes, it might be helpful. However, if it is just a recent problem, it may be more related to his being run down after EBV infection. Still, it wouldn't hurt to consult with an allergist. Specialty Board Certified allergists are also trained in immunology, and so it might not be a bad idea to see one about the whole picture.

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