Doctors Lounge - Infections Answers
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Forum Name: Other infections
Question: Fever of unknown origin
|scrupulous - Fri Nov 14, 2008 10:33 am|
Father is 70, 6', 240 lbs, now 225 lbs. No medical problems & mind & body of 50 yr old. Sat 10/18 fever was 104f w/ flu like symptoms. Continued up/down. No intestinal probs. Thurs 10/23 he had routine colonoscopy. Sunday 11/2 so weak they admitted him to hospital. Battery of tests. Found elevated liver enzymes, clotted vein between liver & intestine & above heart. Culture positive for e coli in blood. Began blood thinners & antibiotics. Fever dropped to 101-102. Released Thurs 11/6. IV Cipro every 12 hrs & Warafin at home. Fever came back up. Sunday was 103f at 4am. Monday 11/10 readmitted. More tests. Cocktail of antibiotics including Cipro. Released 11/13 no fever for 24 hrs. Cultures negative. Can't find any other cause. Zolan every 8 hrs IV. Any ideas. Symptoms are Weak, sweets too sweet, sensitive to light, body aches, fever, chills. No other symptoms. Fever went to 100 last night came down by itself. Docs are stumped. Think e coli introduced by colonoscopy but can't find original cause of illness.
|John Kenyon, CNA - Wed Nov 26, 2008 11:18 pm|
There are some seeming inconsistencies in the story of your father's illness which, if cleared up, might be helpful. First, am I correct that your father had begun running a fairly high fever on 10/18, then five days later underwent a colonoscopy? If so, what was the purpose of the colonoscopy? Was your father still running a fever when this procedure was performed?
More questions: was the vein between the liver and intestine where the clot was found identified? Also, could you please elaborate more on the location of the other clot "above the heart"? Where, exactly, was this clot located?
Has your father been tested for clotting disorders? Even if e. coli had been introduced during the colonoscopy (which would almost certainly have been a systemic infection caused by perforation -- unless the entire procedure was contaminated) the clots would seem to be a different matter.
There is much to be clarified here. I understand the doctors probably haven't made things overly clear, but any additional information would help greatly in leading toward a potential explanation for what's going on now.
Thanks in advance for any additional information you can provide.
|scrupulous - Wed Nov 26, 2008 11:35 pm|
Thank you so much for attempting to form some sort of opinion.
You are correct that Papa began running a fever on 10/18, then five days later underwent a colonoscopy? It was routine preventative & prescheduled The fever was intermittent that week & they felt he was fine to have the procedure.
The vein between the liver intestine where the clot was found was not explained? We were told it was causing problems with the liver & intestine & could have caused the intestine to die had it gone unchecked. Less was explained with the other clot except to say it fed the brain and was somewhere above the heart. We were told the e-coli probably caused the clotting as he has no history of clots. He has never been tested for clotting disorders.
Other than high blood pressure (140/80 average) since he was a teen, and beginning medication for this within the past few years, he has never had any health problems.
I agree that there is much to be clarified here. Since being released on the new antibiotic IV he has improved and stopped running a fever but still very weak and tires easily. Tomorrow is his last IV & they intend on removing the PIC line next week. He wants to start golfing again to rebuild his stamina.
I will post some of the most recent test results in the next post shortly and maybe they can be helpful. The doctors are really at a loss as are we. I'm afraid of a relapse if the cause can't be pinpointed.
|scrupulous - Wed Nov 26, 2008 11:42 pm|
Actually, there have been many tests and it may be easier if you view the list and review the ones of interest for you. If you would be so kind as to email me at email@example.com I will give you the log on information to view the medical test results online. I do not know if my reply to you over this post is private or can be view by all. They are mainly blood tests and also a comment by his doctor about septicemia. Please let me know. Thank you.
|John Kenyon, CNA - Thu Nov 27, 2008 2:00 pm|
Hi there -
This actually is quite helpful, and although the clotting needs further investigation, it would seem your father is doing pretty well now, and probably did suffer sepsis as a result of some unusual complication of the colonoscopy, which perhaps should have been postponed until he was completely well again. However, I know some centers will proceed if a febrile illness seems routine.
I'll contact you via email to see the test results and try to figure out if anything can be drawn from that. Thanks for all the followup and I'm glad your father is feeling as good as he is! Other than this new clotting tendency (which may have been a passing thing), it sounds as though he's definitely on the mend. It would be nice to know just what happened, however. Maybe those results will yield a clue or two.
|scrupulous - Thu Nov 27, 2008 9:38 pm|
It amazes me that you would take the time you have to review this and try to find a few pieces to the puzzle for me. You're an absolute doll.
The way one doctor explained the clotting was as if it was a response similar to a scab and that it would hopefully absorb into the body eventually. I hope he's right. It was so difficult to see Papa so weak at Thanksgiving today. Usually he makes the gravy and carves the turkey but today he slept through that part.
I would be interested in knowing what you might make of some of the tests, they're greek to me. I worry about the liver because of the enzyme elevations initially and I worry that there's cancer lurking somewhere undetectable because that is what they were initially looking for.
Thank you again for your kindness.
|John Kenyon, CNA - Fri Nov 28, 2008 11:59 am|
You're too kind. It's my pleasure to try and help.
After having sifted through all the test results and the findings during his visits, it seems your father may have had something going on in his liver -- some variety of cirrhotic disease caused by something, either chemical or perhaps bacterial -- which is resolving now, but has left him with diminished capacity to metabolize things properly (which would account for the weight loss and lingering weakness). There's nothing in any of the results to suggest cancer. There's a finding of what is probably chronic diverticulosis, and that may even have been where all this began, in a pouch in the intestine, where something may have found a temporary home. All his other blood work is normal or close, although his electrolytes were low during the peak of his illness, something curious but not entirely surprising.
The clot-as-scab explanation is a good one and makes sense.
He'll have to be followed now, mostly via blood tests, unless some new set of symptoms emerge (especially loss of appetite and, especially, any appearance of jaundice). There is one other test that could be done that might be telling, but it's fairly invasive and should be held off unless he fails to bounce back. The liver is the one organ that can, given proper circumstances, regenerate itself, although that doesn't happen overnight. Hopefully you'll see slow but steady improvement in him. I hope you'll stay in touch and keep us updated in any event.
I wish there was more to tell you, but this seems to have been something of an anomaly in your father's case, and hopefully one that will fade into the background now.
Best of luck to you and to your dad.
|scrupulous - Sat Nov 29, 2008 6:08 pm|
What you have provided to me has actually been very informative. Although we're not any closer at finding a cause or a conclusion, at least I have had the opportunity of seeing the situation with a fresh pair of eyes...yours. When I first joined this website I had little expectations of a response and assumed it would be very generic. You have changed my expectations and allowed me to realize that the world hasn't become so selfish and self-centered that one person can't help another out. Reminds me of the days when there was a family doctor that made house calls and stayed for dinner. Thank you again for your kindness and especially for your generousity with our time. You are truly one-of-a-kind.
|John Kenyon, CNA - Sat Nov 29, 2008 9:17 pm|
I'm gratified that my responses have been of any sort of help at all. I do believe support and reassurance are every bit as important as technical skills, and try to make them a part of my approach, at least when applicable. You're very welcome, and it's been my pleasure to try and help sort out your father's problems. I'm very happy you chose to come to this site for help and that you haven't been disappointed. Please do keep us updated, and again, thank you.
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