News  |  Journals  |  Conferences  |  Blogs  |  Articles  |  Forums  |  Twitter   
 

 Headlines:

 
 

Doctors Lounge - Infections Answers

"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."

Back to Infections Answers List

Forum Name: Other infections

Question: Abdominal pain, intermittent fevers and night sweats


 codaym - Thu Feb 17, 2005 5:34 pm

Since Sept. 2004, I have been having abdominal pain (at the waist area), fevers that come and go (usually under 100) and night/day sweats. I have had an abdominal ultrasound, 2 abdominal and pelvic CT scans (both showed mesenteric adenopathy with "extensive" lymph gland enlagement), endoscopy, colonoscopy, etc. The gastroenterologist sent me to the oncologist after the first CT scan. He did not think I had lymphoma but put me through a number of blood tests. When I tested positive for antimitochondrial antibodies, he called in another gastroenterologist and an infectious disease specialist and I was hospitalized with a tentative diagnosis of primary bilious cirrhosis. After many more blood tests, another CT scan, a gallian scan,, etc. the gastroenterologist was confused since my liver function was normal. So it was decided that I should have an abdominal lymph and liver biopsy. This was done and I have a 10 1/2 abdominal scar to prove it. The good news, no lymphoma or cirrhosis. The bad news, after 6 weeks, the biopsies did not grow anything. So we are back to square one with my having daily abdominal pain, intermittent fevers and night/day sweats. The infectious disease specialist is at a loss and now says I need another CT scan in a month and to see him in 2 months. I STILL HAVE DAILY PAIN AND WOULD TAKE ANY DIAGNOSIS THAT HAS A NAME AND TREATMENT!!!!! My husband, co-workers and I think I should be getting another opinion but I don't even know what kind of Dr. to go to. I just don't know what to do and am concerned with being on pain medication forever.

HELP!!!
 Dr. Anthony Solomon - Fri Feb 18, 2005 7:07 pm

Hello,

Have you been investigated for Intestinal Tuberculosis? Have you had a radiological survey of the lungs? Have you experienced any weight loss? Any HIV test done? What was your Erythrocyte Sedimentation Rate? Tuberculosis is primarily a lung infection, but it can infect other areas of the body such as the intestine. Intestinal tuberculosis may result as a complication of lung disease, or be caused by the ingestion of the bacteria in unpasteurized milk.

Clinical features of intestinal tuberculosis include chronic abdominal pain, low-grade fever, night sweats, weight loss, obstructive symptoms, diarrhoea, and enlarged abdominal lymph nodes. It appears that you have four of these features, but that does not necessarily mean that you have the disease. It is not always possible to obtain bacteriological confirmation of the disease by culture., but detection of the tubercle bacilli in biopsy specimens by a method known as PCR is now the most sensitive diagnostic procedure.

I would advise you to go back to your Infectious Diseases specialist to be investigated along these lines, if not previously done.

I hope this information has been helpful, and thank you for visiting our website.


Dr Anthony Solomon
MB BS DTM&H DIP.VEN FRSM
Consultant Physician, Tropical & Genitourinary Medicine
 codaym - Fri Feb 18, 2005 10:08 pm

Thank you for responding.

Yes, while I was in the hospital, they did a skin TB test and the cultures did not grow anything. Also, while in the hospital (16 days - 7 days before surgery and 9 days after), they took blood several times a day and ran tests like crazy. Before I went into the hospital, there were stool samples/testing done as well. There were biopsies done with the endoscopy and colonoscopy as well. The oncologist, gastroenterologist took lots of blood as well. If the Erythrocyte Sedimentation Rate is a standard sort of test, I would suspect mine came back within the normal range. The only blood tests that came back abnormal were the antimitchondrial antibody and M2 antibody tests.

I have lost about 45 lb. since last summer and, at this point, I don't eat much because of the pain. All of the time, I have this aching pain but it intensifies periodically every day. I thought that, somehow, it was tied to how much I ate and how my stomach enlarged. Like it was pressing on something. I tested that theory and it doesn't always work that way. However, I am afraid to eat too much - eat little bits a couple times a day.

I did have a chest CT scan in December that was negative/normal. I believe an HIV test was done at some point along the way but there really isn't any way I could have HIV. The gastroenterologist and the infectious disease Drs. were speculating on TB but they don't seem to think it's a possibility now. I will ask about the PCR test.

Do you additional suggestions? Does it make any sense to get another Dr. involved? I am just so frustrated.

MJo
 Dr. Anthony Solomon - Wed Mar 02, 2005 6:57 pm

Yes, it is reasonable to have an opinion from another Infectious Diseases specialist with sub-specialisation in Tuberculosis. I am very interested in your case, please update me if you have done the PCR test or any further tests. The tuberculin skin test is an unreliable tool in the diagnosis of Tuberculosis.

Dr Anthony Solomon
 codaym - Fri Mar 04, 2005 2:22 pm

I just spoke to the nurse at my infectious disease Dr.'s office. They did not do a PCR test and she wasn't even sure what I was talking about. She said they do them for HIV and for hepatitis. I do have an appointment with another infectious disease Dr. on the 22nd of March and am having another CT scan on the 10th of March. I do not know what, if any, subspecialty this new Dr. has.

On another note, I have a friend whose cousin is a nurse for an oncologist in Boston. She has talked to the oncologist and given him the information I provided here. His comment was that it was "puzzling" and he wanted to know if I had been sent to a rheumotolgist and if I had a PET scan. The oncologist I had seen spoke to a rheumotologist to see what blood tests he would want since it is very difficult to get an appointment with a rheumotologist here. It was in those blood tests that the antimitochondrial antibody positive showed up. He also said that he would be willing to give a second opinion and that I should have the lab results and slide pictures sent up to him. I will probably do that after I see my first infectious disease Dr. in April.

I will give the information you have provided to the Dr. I am seeing on the 22nd (for the second opinion) but am not hopeful that he will provide much. I would really appreciate it if you could give me some additional questions I should ask and/or tests I should ask for.

Thank you so much for your input and caring.

MJo
 codaym - Tue Mar 22, 2005 8:39 pm

I saw the second infectious disease Dr. today. He was quite surprised that the other infectious disease Dr. hadn't begun treating me. He had most of the records from my hospitalization and said that I tested borderline for histoplasmosis. He also said that it is very difficult to grow/identify in a culture. So he gave me a prescription for it. He also said that the last thing he would try would be to treat me for TB. He said that is because I am not in a high-risk group for TB and that TB does not always grow in the culture which is what you already told me. I am, for the moment, going to stick with this Dr. and cancel the appt. with the original. He also said that I should have the CT. scan (day after tomorrow) to see if the lymph nodes are enlarging, shrinking or staying the same.

I looked at the histoplasmosis stuff on the web and don't think I have that but at least this Dr. is doing something. Will keep you posted.

Thanks again.
MJo
 codaym - Fri Mar 25, 2005 8:41 pm

I had the CT scan yesterday. The Dr. I saw on Tuesday called me with the results this afternoon. The scan results are about the same as they were in December with extensive lymph gland enlargement but they are not bigger. They are just not any smaller. So, he said to take the itraconazole and the oxycontin and we will see it that makes it better.

Today was not a good day though. The pain was virtually continuous - maybe tomorrow will be better.

MJo
 codaym - Thu Oct 13, 2005 1:48 pm

Well, I started on the TB medication in July and, with a couple weeks, most of the symptoms had lessened. However, almost immediately, I started experiencing pain in both shoulders and both knees. This joint pain has been increasing and is severely impacting my sleeping (can't get comfortable). My infectious disease Dr. gave me a prescription for Mobic to be taken for arthritis pain. I don't think I have arthritis since it is always both shoulders, knees, hips, elbows, wrists, etc. I am taking Rifampin, Isonazaid, vitamin B6, Uniretic, and Hydrocodone for pain as needed. Since you hit it straight on with the TB diagnosis, do you have any ideas about this? According to what I've read, the joint and bone pain could be caused by the Rifampin but it didn't say what could be done about it.

Thanks,
MJo
 Dr. Anthony Solomon - Thu Oct 13, 2005 3:44 pm

Tuberculosis is treated in two phases - an initial phase using at least 3 antituberculous drugs and a continuation phase using two antituberculous drugs in fully sensitive cases. The use of at least 3 drugs in the initial phase is to reduce the bacterial population as rapidly as possible and to prevent the emergence of drug-resistant bacteria. The treatment of choice for the initial phase is the daily use of rifampicin, isoniazid, pyrazinamide (preferably given as 3 medicines in a combination tablet) and ethambutol for 2 months. After the initial phase, treatment is continued for a further 4 months with rifampicin and isoniazid, preferably given as two medicines in a combination tablet.

I note from your prescription that you have been receiving only two antituberculous drugs right from start of treatment. The drug "Uniretic" which you are prescribed is a blood pressure medication - are you hypertensive? Vitamin B6 (pyridoxine) is prescribed to prevent the common side-effect of peripheral neuropathy associated with isoniazid.

The commonest side-effects of rifampicin are gastrointestinal disorders and liver toxicity. Bone pain, muscular weakness and muscle pain are reported but are less common. I am more concerned that you did not start treatment correctly for the first two months, unless this was an error in your post. For the pain, I would suggest simple analgesics, but if unbearable, see a rheumatologist for an opinion. I am delighted that you are experiencing an improvement in your condition, and that at The Doctor's Lounge we can sometimes help to suggest a diagnosis for the patient without physical examination.

Dr Anthony Solomon
Consultant Physician, Tropical & Genitourinary Medicine
 codaym - Thu Oct 13, 2005 5:53 pm

Sorry, I forgot to mention that I took Avelox for the first 2 months. I'm assuming that is what you are talking about. I take the Uniretic because my blood pressure tends to fluctuate and my regular Dr. wants it to be more stable. I just included it in case there was some interaction. The problem with the pain is the lack of sleep it is causing but I'm going to try Ambian tonight and see if that works. Otherwise, I'll either have to see if there is something else I can take or I'll just have to tough it out.

MJo
 Dr. Anthony Solomon - Fri Oct 14, 2005 7:21 am

AVELOX is a prescription oral antibiotic that has been shown to kill the types of bacteria that commonly cause adult respiratory tract infections but not the bacteria that cause Tuberculosis. So, you must discuss the issues I have raised with the doctor who started you on anti-tuberculous treatment. What is worth doing, is worth doing well.

Dr Anthony Solomon
Consultant Physician, Tropical & Genitourinary Medicine
 Dr. Anthony Solomon - Sun Dec 04, 2005 7:56 am

Please post an update on your condition. We are always interested to hear of any progress you have made.

Dr Anthony Solomon
 codaym - Thu Dec 15, 2005 11:50 am

I spoke to me Dr. as you suggested and he told me that I was on an acceptable course of treatment. Don't know what else I can do. However, any progress that I had made in the late summer is gone now. The pain, fever and sweats have all returned and now I have Fentanyl patches for pain since the Oxycontin and hydrocodone aren't always effective. Had another CT scan on Tuesday with the results being the same - no change. My Dr. has said that he really doesn't know what's wrong with me. I am not hopeful that there will ever be any resolution and I will just have to live with this forever. I think I need a miracle.

MJo
 BUSCHCLUB - Wed Jan 04, 2006 10:17 am

try call mayo clinic or a good university hosp. at most of these places you can make an appt. yourself maybe this will help.
 codaym - Wed Jan 04, 2006 11:01 am

Had another CT scan on the 21st of December. This time a thickening of the wall of the small bowel showed up. Was told this could either be Crohn's disease or a problem with the blood supply to my small bowel. Dr. said that Crohn's would answer all the symptoms that I've had and I now have an appointment with the 4th gasterenterologist. He put me on Flagyl and I do feel a lot better. Maybe there is hope.
 Dr. Anthony Solomon - Sun Jan 15, 2006 6:00 pm

It is always good to be optimistic in times of illness.
Take the advice of the previous site visitor and be investigated at a tertiary institution, such as a University Teaching Hospital.
I am confident that your condition will be investigated and managed better in such a setting.
 codaym - Wed Jan 18, 2006 4:49 pm

Saw the gasterenterologist on Monday. He reviewed everything and scheduled another endoscopy using a pediatric endoscope. Said that he could get several feet into the small intestine with it and would do biopsies. The thickening is "diffuse" which he said meant everywhere. He said he would not diagnose it without some concrete evidence and that if this doesn't demonstrate something he is going to refer me to Mayo. Said that with all that has been done to me, there should be an answer. This procedure is scheduled for February 27th so I won't know anything until after that.

I really would like to thank you for your concern and correspondence. Wish I were in the UK!

MJo
 sallyboof - Sun Jan 29, 2006 6:32 am

hi just reading what you have to say and it sounds exactly like my boyfriend he has stomach pain night sweats all his lymph nodes are swallen and blood test shows infection. it all started jan 2004 and is still going on first they thought he had lymphoma and then that was clear so they tested him for hiv hep and all other things that they could think of that was the infectous diesease doctors then they thought he might have crones deisease but he did not then he started to get mucsle spasms and shoulder pain he has had heaps of blood test 1 stomach and 2 lymph node biopsys and still no answers he has lost heaps of weight due to not eating because of pain or not keeping food down went to see neurologist and they cleared him for muscle or nerve dissorders.

the doctors all came back with same answer they just don't know and they all say they will just have to try to manage the pain but medication only works for a couple of weeks then we back to the start but for the past 2 months he has been see a chinese accupunturist and herblist and feels ontop of the world so we have our fingers crossed that it lasts but the chinese docter is very confident. i hope that things work out for you
 codaym - Thu May 25, 2006 10:58 pm

Well, the endoscopy and biopsies didn't show anything. The Dr. did a couple more blood tests which, also, showed nothing. So, they did another CT scan which showed that the lymph nodes had stabilized but the small bowel thickening is still going on. Now, they've done a capsule endoscopy which showed many "spots" on the walls of the small intestine. Next week, I'm supposed to go for more blood work that has to be sent to California for testing. It's the only place (?) that can do the test and it's "definitive" for diagnosing crohns. The Dr. said that he thinks "we are getting close".

Thanks again,
MJo
 Dr. Anthony Solomon - Thu Jul 13, 2006 6:40 pm

Please update us on your present state of health and results of blood tests expected from California.

Dr Anthony Solomon
 codaym - Thu Jul 13, 2006 9:30 pm

Well, the initial test at the California lab was positive for Crohn's but, when they did the more discrete test, it wasn't. The GI Dr. said that "before we go half way across the country" he and the Infectious disease Dr. would "reluctantly" put me on Prednisone. After being on it for 2 weeks, on the 4th of July, I went into the hospital with several partial small bowel blockages. They called in the surgeon but she thought that it was due to inflamation and didn't want to slice and dice. So they kept me for 4 days with lots of antibiotic and pain medication. They did the upper GI barium thing at 3 days and the small intestine was normal. I was sent home the next day and have another colonoscopy (going to get a small intestine biopsy from there). After that, the GI Dr. said that he may have the surgeon go in and look around. After that, it will be going to Mayo for some new kind of scoping with balloons. Since I came home from the hospital last Saturday, I've lost an additional 8 pounds and seem to be running a constant 99.5 or so fever. The GI Dr. said that I will need to do something if it gets over 100.

Haven't had any breakthrough pain for a couple days. I'm on 90 mg oxycontin (30 mg 3 times a day) and have hydrocodone for breakthrough. I'm on Flagyl and some other antibiotic. Still on 40 mg of Prednisone a day for another 10 days and then I start dropping it by 5mg a week.

The GI Dr. said that he has a "working" diagnose if Crohn's but really isn't sure.

MJo
 codaym - Tue Nov 21, 2006 10:42 pm

I just got out of the hospital last Thursday. Was in for 16 days and had abdominal surgery to remove "extensive" small intestine scar tissue. The surgeon wanted to remove a portion of my small intestine at the same time but, since I'd been on the table so long by that time, he didn't. I just got the staples out today.

I am moving to Texas in a month and the surgeon said that I should find a good GI as soon as I get there. He believes that I have crohns disease and have had it for some time. The GI Dr. doesn't really know what to think.

Suggestions/ideas?

Thanks,
MJo
 geoff73 - Tue Nov 11, 2008 12:13 pm

I have been having night sweats or soaks,difficulty urinating and pain in my left lower abdomin.I have chest tightness and pain in my left testical.this has been going on for six years now I have seen several doctors and have had chest x rays and blood work ups.nobody can figure this out.I don't have alot of money so most of my care is from our local hospital.This is effecting my way of living.And the way I treat others.PLEASE HELP!!!

|

Check a doctor's response to similar questions

 

advertisement.gif (61x7 -- 0 bytes)
 

Are you a Doctor, Pharmacist, PA or a Nurse?

Join the Doctors Lounge online medical community

  • Editorial activities: Publish, peer review, edit online articles.

  • Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.

Doctors Lounge Membership Application

 
     

 advertisement.gif (61x7 -- 0 bytes)

 

 

Tools & Services: Follow DoctorsLounge on Twitter Follow us on Twitter | RSS News | Newsletter | Contact us

 
Copyright © 2001-2010
Doctors Lounge.
All rights reserved.

Medical Reference:
Diseases | Symptoms
Drugs | Labs | Procedures
Software | Tutorials

Advertising
Links | Humor
Forum Archive
CME Articles

Privacy Statement
Terms & Conditions
Editorial Board
About us | Email

We subscribe to the HONcode principles of the HON Foundation. Click to verify.We subscribe to the HONcode principles.
Verify here