morning shaking chills and 102.5 fever every few weeks for 6 months

Question

My wife, age 62, has been having up to three hours of recurrent SEVERE shaking chills (includes moderate nausea) almost immediately followed by several hours of fever, right around 102.5, followed by at least 24 to 48 hours of extreme fatigue. These episodes began about 6 months ago. At first they were spaced 3-4 weeks apart but now they are spaced 2 weeks apart or less. She has mental confusion (a 'fog') following. There is a moderate headache in the beginning.... She has a porcine mitral valve, moderate COPD,hepatitis C for 40 years with no symptoms, MGUS (monoclonal gammopathy of uncertain origin).... A very sharp former primary first guess was Lyme's disease or some form of meningitis or encephalitis. (Can't remember which?) ...Has had many recent blood cultures, brain MRI, EEG, chest scans and all are negative except one thyroid test indicated hypo or possible pituitary but two following were unremarkable.Some physicians refer to this as 'non-specific'. To my mind there is nothing non-specific about this. The symptoms are like clockwork. We live in an area of North Carolina with three different eco systems, almost tropical in some respects. Is malaria a possibility? Lupus? Trying to rule out rather than pinpoint. She did have excessive sudden weight gain prior to these episodes. Some face swelling. Itching feet. Real bad cramps in her calves at night possibly RLS? Also felt out of sync .. bad timing!? Of course, Takes a host of meds including steroids for COPD and sinusitis. Same doctor figured auto-immune CNS infection? Appointments scheduled for Infectious Disease and Rheumatology at large teaching hospital. Can anyone suggest the best hospital for stuff like this? Would appreciate any help here. She believes that she may already have some related cognitive, balance deficits. Thnking you in advance for any analysis. Jack

KMathurMD · Answer

Hi
I am sorry you feel that way. I can understand you are worried about your wife. However all fevers with chills are not malaria. Glandular fever, endocarditis, PID, many autoimmune diseases and many cancers present this way. Agreed, that since you live in an area with near tropical climate, malaria is a possibility. For a fever that has been persisting for some time testing for PUO makes sense as this runs a wide battery of tests to cover all possible causes. Without examining your wife I cannot really comment. I can only advice that in a condition like hers it will be wiser to broaden the search for a possible cause than narrow it down to just malaria or Lyme’s.

Please let me know if there is any thing else and do keep me posted. Take care!

chucomsen · Answer

Quite a laundry list. I could have come up with a similar list from any book or many websites. My wifes symptoms are very specific and would likely exclude many of the items on your list. Thanks but your list is useless.

KMathurMD · Answer

Hi 
Thanks for writing to the forum! 
For any fever of prolonged duration you have a battery of tests called tests for PUO or pyrexia of unknown origin. In your wife’s case it could be due to endocarditis.
Recurrent or chronic fever is seen in tuberculosis, SLE, rheumatoid arthritis, Polyarteritis nodosa (PAN) and other auto immune disorders, UTI, drug fever, glandular fever, HIV, STDs, endocarditis, parasitic infestations, fungal infections, lymphomas and other cancers etc. Polycystic ovary, menopause, PID (pelvic inflammatory disease) should be investigated for. 
Ofcourse, a number of times no diagnosis can be reached and the fever subsides after some time.
A comprehensive investigation is required keeping all the points in mind.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!

chucomsen · Answer

In my wifes opinion (she is the patient) and mine, classic malaria symptoms of severe shaking chills (rigor) followed nearly immediately by fever (over 102 degrees) followed by sweating and than extreme fatigue over 24 hrs or more are exactly what she experiences. But she has not been out of the country in nearly 40 yrs. Additionally, suddenly she has a upper left abdominal hernia (probably not hiatal) which has me considering enlarged liver and/or spleen (even though gastro guy never mentioned possibility!!??) frequently associated with malaria, lymes disease etc. We will also be agressively pursuing abdominal soft tissue scan today or tomorrow. What else can I do? Jack