My 19 year old son has been running a fever for over 7 days now. Six days ago he went to the clinic with a fever of over 105. That evening he was admitted into ER when he passed out after having his blood drawn twice. He was very pale with very swollen lymph nodes. He was tested for mono, but the test came back negative. The ER doctor said that his symptoms were so classic of mono that he still believed it was mono because the test was only 85% accurate. On Monday we returned to the clinic (which is at a hosptial.) He was admitted into the hospital that evening. At first they said he had a lot of protein in his urine and some traces of blood. They ordered a sonogram of his kidneys the next day, but they were fine. They have done a great deal of blood work, though I don’t know what all they have looked for. A second, more involved, test for mono was done… but we don’t have the results yet. The doctors are saying that they do not know what is causing the infection. At first, they did not want to give antibiotics until they found the cause. But, last night they started him on Clindamycin, 600 mg every six hours.
There are several things that concerns me. I will list these things below:
Starting around the November time frame, he began to sleep all the time. He stopped going to classes at college because he could not get up to go. He would sleep all day until the evening, and wake up still looking tired. At first I thought maybe he was staying up all night on the computer. But, I removed his computer and video game systems from his apartment and explained that I was concerned and wanted to see if that caused a change. It didn’t make a difference though. He still slept all day though he was home at night and had no computer or video games. He has always been self motivated and responsible when it comes to school, but in the past few years I felt that was changing. At first I thought it was something emotional or mental going on like depression. He has been through a lot. He comes from divorced parents, but I remarried when he was not quite four years old. He called my husband “Dad” and my husband was very much a dad to him for 10 years. But, in 2000, my husband was killed. I thought that perhaps his not dealing with so many emotions might be causing him to feel depressed. But, about a month ago, I began to realize that the changes weren’t all emotional or mental. I began to become very concerned because I felt there was something physical going on with him.
Several years ago, his hair began falling out. He isn’t balding, but it falls out all the time. It is all over his sink within a day or two, and he can run his fingers through his hair and have hair in his hands. I also realized that there has been a physical change in him that has actually been progressing since he was around 12 or 13. He had always been active and played baseball (since the age of 6.) But, I remembered that even when he was around those earlier ages he would get so tired if we walked a long ways… especially in heat. Most kids would do fine, but he would have to stop. From the age of 13 on, I can look back and see a slow decrease of energy through the years. I thought it was due to the tragedy we went through and going to live with his biological father afterwards. But, during the last year of high school, he began to look tired all the time. That is when his hair began falling out. Then in November, he just never had any energy and slept all the time. His speech sometimes seemed muffled or slurred. He’s just been “dragging” for several years, and it has gotten worse since November.
About a month prior to this current infection, he went to a 24 hour clinic for a fever and a sore throat. The doctor diagnosed him with strep, but she never even took a throat culture, so we don’t know if he really had strep or not. She put him on Amoxicillin for 10 days, and he finished the course. About a month later… this current infection begins. He was in the hospital from Monday night until Wed. night.
Wed. morning he was having a severe pain in his chest, and he said it hurt to inhale and exhale. He had pain in his left shoulder blade, neck and arm. They gave him Malox for heart burn. I am concerned about his heart, even though he is only 19. I am concerned for several reasons. One: He had something similar happen to him when he was 11 months old. He ran a fever of 106, and I could not get it to come down with Tylenol and sponge bathing him. I took him to the ER and he was admitted into the hospital. He had very swollen lymph nodes at that time too, and his white blood cell count was extremely high. Even after he was on IV, had been given more Tylenol and the nurse and I were sponging him… his fever would not go down. I remember her saying to me that we had to get that fever to break or it could cause damage to his heart, and I remember her saying that it might not show up until later. Two: My father had a bad heart valve. He had his first heart attack in his early to mid thirties. After his second heart attack, they discovered that his valve was bad and replaced it, but they didn’t know if it was caused by high fever when he was young or if he was born with it. They said it was one of the two that caused it.
Another concern I have is the possibility of auto immune diseases. We just went through a similar thing last year with a family member (though not blood related). They thought she had mono, but that came back negative. After many tests, she ended up in a hospital with a doctor that specialized with auto immune diseases. She has Lupus.
I’ve mentioned both of these concerns to the doctors, but they don’t say much about it… yet they are concerned that they don’t know what it is causing this. They did an EKG, but I have read and heard that an EKG might not be appropriate or accurate enough for certain things. I have also read that if the heart is damaged, it doesn’t necessarily mean that there will be a heart murmur. I have read that if it is in the right side of the heart, you won’t hear one. Is this true?
One other possibility they are looking at is food bacteria. He said he ate some turkey that had been sitting out for 10 hours. I realize that the possibility of bacteria in the turkey is likely… but it would not explain the previous already existing symptoms over the past few years that started to get worse last November.
One last thing I will note… he had some sort of bubble on the end of one of his fingers. It looked full of puss and had a greyish color in the center. He said that he did not ever recall getting anything in his finger, and that he just woke up with it there one day.. about the same time as the fever began. On the second day of being in the hospital.. the bubble went down…it was flat. Today, it has peeled and left an indention in his finger. Are there any infections that could start with something like that and affect the body in other ways like the lymph nodes and possibly the heart?
I am hoping that you can give me some ideas as to what possibilities might be going on here, and that maybe you might have some articles that I can read and ask my son’s doctors about.
Dr. Joshua’s Answer:
I’m sure he is being properly examined. Given the above history, I’d especially like to see chest X-ray, Sinus X-ray, WBC (blood cells and haemoglobin), TSH, T4, T4V (Thyroid function).
The acute illness is high fever, unknown focus (cause, origin). Standard examinations include urine, chest X-ray, sinus x-ray, with a fever of 105 a blood culture is advised. It’s hard for me to make any guesses as I don’t have the results of the examinations. I’m sure the doctors have done the basic workup. They started him on empiric (trial) iv antibiotics. Is there any response?
Mononucleosis is a possibility.
As for the other symptoms, those that have been ailing him for years. Fatigue, disturbance of sleep rhythm, hair loss, etc. Thyroid function needs to be checked. Also, a thorough physical examination is needed. Depression is also a possibility - a consultation with a psychiatrist may be beneficial. Also, in his case a neurological examination is needed because of the speech disturbances.
These are just general outlines. It’s hard for me to recommend anything without physically examining him. When he recovers from his current acute illness, take him to the family doctor and express your concerns about the long-term symptoms.
He is already 19 years old - it may be better that he goes to the doctor unattended by his mother. My experience is that parents of young adults should generally not be present in the doctor’s office. Their presence deteriorates the quality of the doctor-patient contact and makes an objective evaluation more difficult. Often the young patient will not disclose of sensitive, essential information if their parents are present.
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