Question: Hi,
My sister is 26 year old and has very low haemoglobin. It was around 9-9.5 and we thought of consulting doctor. Around 3 months ago Doctor put her on iron tablets. After few days she developed severe joint pain (knees, elbows, shoulder, neck) and they even started swallowing. She also started getting a lot of fever (of the order of 102-103). At the same time doc conducted one blood test and her esr was found elevated. She was then put on calcium tablets. Her joint pain has definitely reduced but since then she has been suffering from frequent fevers. Also, her ESR level reached very high levels(recent result shows 140 mm/lst hr).
The doctor conducted few tests for artheritis but all were negative. Chest X-Ray and Ultrasound (abdomen) too didn't reveal anything. Everything was fine. Apart from elevated ESR (140) and low Hb (8.6), everything was normal in her latest blood report including (WBC, TLC, platelet count, leucocyte count ).
It has been around 1.5 months that these cycles of fever has been going on. A slight increase in pus cells were reported in one of the urine tests but nothing else. I also observed that as and when she gets fever as and when feels slight restless and the fever accompanies with pain in her one of the knees.
We are completely clueless about all these proceedings . could you please advise regarding this and let us know what probably could be the reason behind this.

Thanks, XXXXXXX

Hi,

Thanks for the initial analysis. Please find below the replies to your questions.

1. Is she having other symptoms like cough with or with out sputum?: No. No cough at all.
2. What happened to her appetite, is it normal or reduced?:Her appetite is definitely reduced.
3. Did you notice any weight loss during this period? Yes.

Also, please note that the frequency of high temperatures is around 5-6 days and that accompanies with body pain. Interestingly, for the last two days she has just been suffering from severe body pain but no fever. Earlier it used to only be the knees, shoulders, neck but now she is feeling pain in entire body. No headache.

Thanks, XXXXXXX

Hi,

We would definitely act upon your advice and go for the recommended tests.

But what if the tests are negative, I mean if possibility of TB is ruled out then what could be the other possible reasons behind this chronic infection.
I hope you understand my concern because so far we haven't been able to find out the root cause of her illness owing to which we are not even close to the appropriate treatment. I have read about other ailments which could cause elevation in ESR levels (some of which are very acute diseases). But they are either not diagnosed or haven't been tested for yet.
Please advice Sir.

Thanks, XXXXXXX