Where is her fever coming from?

[valere]

Dear All,

My girlfriend (she is living in Moscow Russia) is now already 1 month in a hospital going through all kind of tests without results and we are becoming desperate. For this I post "the story" on this board in the hope someone can help us with giving a direction of solution.

It started 2 months ago with a swollen groin lymph, this swollen lymph was sometimes painless, sometimes not. After a few weeks she started have skin rash ((red small dots, itching) and after a few days she got fever, first mild but after a while very high for which she needed assistance with intraveneus injections. This fever comes in waves without clear pattern however. As her condition became worse and worse (pain in joints and muscles) she was taken to a hospital for investigation. As they suspected an infection they placed her in the infection department. After a week they made the diagnosis 'Brucellose" and started an antibiotica treatment. The antibiotica treatment they gave her was worsening her condition (pain in joints and muscles and rash became worse ) as probably she is abit allergic to the kind of antibiotica they gave her. She was moved to another hospital (why is still unclear). In this other hospital they didn't believe the diagnosis and started the investigation from scratch. Meanwhile, after 4 weeks, she was tested on lymfoom, all major infections (including Lyme, Brucellose and pseudo tbc ...) but with all negative results. At a certain moment they started another antibiotica treatment (same family as the first one we found out after my girlfriend reacted allergic again). She also got an ultrasound of the heart and a gastro endoscopie (no results).

As we don't get a lot of detailed information from the doctors (local practice?) we are thinking of leaving this hospital. But my friend still has these fevers, which makes her exhausted, she sleeps too little, her global condition is in other words bad, only the pain in joints and muscles is completely gone after they stopped first session of antibiotica.

Can someone help with giving a direction of solution? Are there very rare infections with these symptoms which they might have overlooked, is it may be an allergy or something else?

Thanks upfront for your advices.

[kkmalaysia]

What they are investigating is along the infection line. Anyone has ruled out hematological malignancy like lymphoma? Any peripheral blood film done? Can you post her blood investigations here like full blood count, liver function test, renal profile etc.?

[valere]

At the moment we don't have any results (bloodtest etc..) in hands. We hope to get copies of tehm but it seems not so evident in this country. Once we have them I will publish some.

Thanks for reply!

[mediconweb]

It does seem from your post, that she has gone through and is going through course of various antibiotics. It also appears that there are no symptoms now. Only the fever persist. So, I would conclude that fever is the main criteria now. She also feels very weak. I do not know whether her blood tests show any infection, but feel that with all those blood tests done, blood culture and sensitivity must also have  been  done and antibiotics administered accordingly.
Brucellosis is an infection which is transmitted to humans by direct contact with animals like cattle, sheep, goats, swines and dogs. It can also occur by consuming raw dairy products. Has she been in contact with such animals ? Treatment is long and takes time to eradicate the chronic infection.
To summarize:
1) Kindly confirm if Brucellosis was present. If so, persist with the treatment.
2) If not, the enlarged lymph nodes could have been due to a localized infection, which has gone after a course of antibiotics.
3) The skin rash could have been due to allergy to the antibiotics.
4) Only fever and weakness are present now.
5) Pathology and diagnosis show no underlying cause of fever.

My impression from what ever information provided:
If Brucellosis has not been confirmed or has been eradicated, the fever and weakness could be due antibiotics and other drugs being administered. It is called " Drug fever". Leave the drugs and the fever will leave.
However, this is an impression from thousands of miles away with not enough information on hand. Only the physicians on hand will be the best advisers.