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  • #457429
    MLTelfer
    Participant

    Hi All-
    Maybe somebody has heard of this as it may be autoimmune. After significant testing with no evidence of any disease, my wife has been diagnosed with FUO (fever of unknown origin). Has anybody come up against this?

    #457430
    Lynne G.SD
    Participant

    Hi ML;
    Many diseases take years to manifest themselves.Looking back I can see that I had the beginnings of SD when in my early thirties and did not get bad enough to get a diagnosis until mid fifties.
    Could you post the results of her testing such as Sed/Crp/Ana etc. etc as these might give us clues.I have several years of medicine under my belt and have never heard of FUO and think that might be an other garbage can diagnosis just like fibromialgia.There is a real fibro but doctors ten to use that diagnosis when people have general pain and that is not correct.

    #457431
    Calida
    Participant

    Fever of Unknown Origin is considered a diagnosis in medicine with its own ICD code for billing purposes. It indicates an infection of some sort and is usually a temporary diagnosis until the virus or bacteria is identified. When the source of the fever can’t be identified, the diagnosis of Fever of Unknown Origin remains.

    ML, does your wife have any signs or symptoms of illness besides a fever? How long has she had the fever? A chronic, low grade fever, under 101 F, can be an early symptom of AI disease but it can also be many other things and the cause may never be discovered.

    Dx: Diffuse Systemic Sclerosis/SLE overlap, Raynaud's June 2013, Lyme August 2013
    AP: Azithromycin (Teva) 250mg BID, May 2014, Clindamycin 600mg every 8 hours for 2 weeks July 27, 2015 - Aug 10, 2015
    Minocycline (Teva generic) 100mg BID November 20, 2014
    Meds: LDN 3.5 mg, Prednisone 5 mg (discontinued), Aspirin 81mg, Liposomal Artimisinin 50mg QID x 3 weeks, 4th week off, rotating (discontinued May 2015, restarted 2016 7 days per month), Daily Nystatin, 2 tabs BID, as a preventative measure
    Supplements

    #457432
    PhilC
    Participant

    How high is the fever? Is it constant, or does it fluctuate? How long has she had the fever?

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #457441
    MLTelfer
    Participant

    Sorry for not getting back sooner. Her fever holds steady from 99.6 to 101.8 as a range. Made it as high as 102.8. It has been a month now. Her CRP made it to 67.5 and ESR to 120. She has a rash on her hands so endocarditis has been eliminated after testing. Her fingers turned purple in the cold. Two infectious disease doctors say it is not infection. She is cleared of malignancy. She was in the hospital for 5 days and has 60 pages of blood tests, radiology etc. The doctors in the hospital said she had a million dollar work-up and nothing is there but fever. We went to her primary care doctor today and she characterized it as a billion dollar workup. She was tested for rheumatic diseases too. It is a mystery I guess. It is exactly as they say: fever of unknown origin.

    #457442
    Calida
    Participant

    Labs, rash and Reynaud’s makes me think systemic lupus as a first guess. They were the early signs, along with a low grade temp, I had and it took at least a year before the positive ANA and lupus antibodies appeared in my lab results. Elevated ESR may indicate erythrocyte infection or compromise and I believe that’s why Plaquenil is somewhat effective in so many AI diseases. The immune response of increased temp is a healthy response to infection but the chronic fever indicates the immune system is fighting a tough bug and not winning. I think my fever lasted about 6-8 weeks before it disappeared and lupus symptoms started popping up.

    I, too, had the billion dollar work-up with negative results. The initial lupus diagnosis was purely clinical. One test you didn’t mention, though, was Lyme testing via Igenex. My commercial lab western blot was initially negative but the Igenex results were positive. A year or so later, the commercial lab WB was positive.

    I wouldn’t rule out RA, scleroderma or MCTD either. Whatever is going on, it’s a systemic, most likely bacterial, inflammatory condition. With malignancies and, I suspect, leukemia ruled out, it does seem that AI Disease and/or Lyme is the most likely suspect. I did hundreds of initial diagnoses that started with fever of unknown origin. When sepsis and cancers were ruled out (common in the elderly), the presence of Raynauds pretty much indicated an eventual autoimmune disease diagnosis.

    There’s always the chance the fever will be effective and AI Disease dx may be postponed or avoided so keeping my fingers crossed for your wife.

    Dx: Diffuse Systemic Sclerosis/SLE overlap, Raynaud's June 2013, Lyme August 2013
    AP: Azithromycin (Teva) 250mg BID, May 2014, Clindamycin 600mg every 8 hours for 2 weeks July 27, 2015 - Aug 10, 2015
    Minocycline (Teva generic) 100mg BID November 20, 2014
    Meds: LDN 3.5 mg, Prednisone 5 mg (discontinued), Aspirin 81mg, Liposomal Artimisinin 50mg QID x 3 weeks, 4th week off, rotating (discontinued May 2015, restarted 2016 7 days per month), Daily Nystatin, 2 tabs BID, as a preventative measure
    Supplements

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