What Causes Severe Fever Along With Pain In Ribs?

Posted on Tue, 7 Apr 2015

Question: I am getting mild fever mostly during evening times (99.3 to 100) since last three months. The fever is erratic, some time it is there during the morning as well. Whenever the fever is in the morning, it is usually higher in the evening time. I also have pain in my ribs which is more when I lie down to sleep, change position while sleeping, coughing or sneezing. The pain is also there on the front center in the bone. The pain is there even before the fever started.

Before all this started I had cough for around one month which was coming and going. Later I took antibiotics it subsided but I still have discomfort in my throat. The sputum causes irritation in the throat which causes cough. I think I have mild tonsils as well.

I also have a history of acidity, usually I had to take antacids before sleeping to prevent burning sensation in the middle of the night.

I have also lost some weight (around 4-5 kgs during last three months) and also feel a bit weak. Please help me as I am really worried.

Answered by Dr. Pradeep Vitta (2 hours later)

Brief Answer:
Are there any swellings in the neck, axilla or groin that you can feel?

Detailed Answer:
Hi,

Sorry about the continuous bouts of fever that you have been getting. I have gone through your list of symptoms. If it hasn't abated with all the medications it obviously needs further investigations. Before that I want to ask you a few more questions regarding the physical examination.
Do you have any swellings in the form of bumps in your neck, just above your clavicular bone, in the underarm or groin?
Also I would suggest you to get a Chest Xray if you haven't got it yet or upload it if you had it done in the recent past.
Another investigation to be done is a peripheral smear to look for malarial parasite at the peak of fever. Generally if not taken correctly at the time of fever, then the parasite is missed. Another thing that goes in this favor is that antimalarials had reduced the chills. Also what all antimalarials have you taken? Can you list them here?
What was your weight before it had reduced by 4-5 kgs?

Please get back with the above details and I will check them up and guide you. Repeating a CBC with ESR and CRP with differential count too helps

Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Pradeep Vitta (23 hours later)

Hello Sir,

Thank you for your reply.

I do not have any swelling/bumps in my neck or above clavicular bone or in the underarm or groin. But I have some bone pain in the middle of my chest, I think below sternum. And as mentioned earlier, I have pain in my ribs (especially when deep breathing, sneezing or coughing). Sometimes there is pain in the left shoulder blade (which goes on and off).

I’ve got my Chest X-ray done several times, I am attaching the reports.

I’ve also got Pheripheral Smear, ESR, Blood Sugar and TSH done today, reports are attached

The antimalarials i’ve taken are:
Tab Zanocin Plus 200 (Morning and Evening)
Tab Arflur 3D (Three times)
Cap Esogard (Morning and Evening)
Tab Lumerax 80 (Morning and Evening)

Earlier my weight was 78-79 kgs but now it has reduced to 74-75 kgs.

I’ve also attached recent blood reports that I got done recently.

Thank you in advance for looking into this matter and guiding me.

Regards,
XXXX

Answered by Dr. Pradeep Vitta (19 hours later)

Brief Answer:
I think it must be investigated as Fever of Unknown Origin

Detailed Answer:
Hi,

I have gone through your reports and everything seems to be normal except your ESR, which has increased marginally. However I want to confirm if the blood sample given for Malaria test was taken at the peak of fever or not?
And regarding the substernal discomfort, I think it can be due to acidity too. Are you on any antacid? If not, I think you should ask your doctor for a prescription of Omerprazole or Pantoprazole which should regulate it. Generally taking all those tablets exposes the stomach to such episodes.

How are the fevers now? Are they still continuing or have they subsided? It would be helpful if you can maintain a temperature chart or diary to note how it fluctuates.
If possible I would suggest you to do following investigations,
Liver Function Tests (USG showed altered liver echotexture)
Blood Urea and Serum creatinine
ANAs (Anti-nuclear antibodies), CRP
and a repeat USG of abdomen pelvis if possible.

Also please send the Chest Xray image instead of the report. Hold it against a tube-light and take an image with a camera if possible. Try making sure the image is clear.
Another question, in your profession or otherwise do you deal with any cattle or animals etc?
Do get back to me with the above answers, and get started on an antacid like I mentioned.

Regards
Pradeep

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

Follow up: Dr. Pradeep Vitta (2 days later)

Hi Doctor.

Thank you once again for your reply.

Even I think that this must be investigated as Fever of Unknown Origin.

I have redone the Malria test during the peak of fever in the evening, reports attached.

The substernal discomfort, it could be due to acidity but the kind of pain I feel is in the bones, the entire rib structure pains. If I am sitting without any support for long duration, I start getting pain in the sides of my lower ribs. Sometimes the pain is more on the left shoulder blade. However, I have a prescription for Pantarpazole, I can start that right away.

The mild fever is still there, yesterday it was 99.6 during the evening time, today it was 99.3 at the same time. I will maintain the chart to see the fluctuation.

I have done the below investigations and the reports are attached:
Liver Function Tests (USG showed altered liver echotexture)
Blood Urea and Serum creatinine
ANAs (Anti-nuclear antibodies): Samples given but reports will take minimum 3-4 days

I’ve also attached Chest Xray image.

I am a graphic designer by profession and I do not deal with any cattles or animals.

Please let me know if any more information is required from my end.

Thank you,

XXXX

Answered by Dr. Pradeep Vitta (14 hours later)

Brief Answer:
I am not able to see any new uploaded reports

Detailed Answer:
Hi,

I don't see the chest xray images uploaded and the new LFTs and Urea Creatinine reports.

If you have any trouble uploading them you can also mail to YYYY@YYYY with Subject as Attention: Dr Pradeep Vitta. It will get uploaded here.

As for the pain, do you find the pain localized in the left shoulder region or does it also radiate to the left arm and left side of neck? Yes do continue the antacids. At the least it will prevent acidity. What all medications are you on now?

Please do get back with the reports of ANAs too and we can plan further management.

Regards
Pradeep

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Pradeep Vitta (1 hour later)

Hi, I have provided some attachments. Please review them.

Answered by Dr. Pradeep Vitta (1 hour later)

Brief Answer:
All the reports are fine. We must now wait for ANAs and CRP results.

Detailed Answer:
Hi,

I have gone through those reports. The Chest Xray has got nothing remarkable that can explain your symptoms. I think we must now wait for the reports and decide on the further course.

Please get back to me with the characteristics of the pain. Does it travel anywhere else or is it localized? Any tingling or numbness or weakness in the hands specifically the left hand. How severe is the pain on a scale of 1 to 10 with 10 being the severe-most pain you have had. Let me know all the medications too that you are presently taking.

Regards,
Pradeep

Above answer was peer-reviewed by : Dr. Shanthi.E