Fever of Unknown Origin

In nursing school, there was a saying "if you hear hoof beats, look for horses and not zebras".  This means look for the common illnesses such as ear infections, strep, urinary tract infections, pneumonia, etc. before considering more rare disorders/infections. The thing is, if you are an overly anxious mother who happens to work in medicine, you only hear zebras.  

Photo: www.livescience.com

Bear has missed a fair amount of school and therapies and play dates due to random, recurrent fevers.  These fevers are not all that exciting.  They are low grade--ranging from 100.5-101.2.  They typically last less than 24 hours and present mostly in the mornings within a few hours upon waking.  Her only symptoms include decreased appetite and agitation.  There is no pattern to these fevers.  They occur anywhere from 2.5-7 days apart.  

At first, I wasn't tracking them.  Then I noticed that there seems to be an inordinate number of fevers in a short period of time.  I thought perhaps Ellie just ran hot.  Maybe 100.5 is her normal temperature.  Twice daily tracking proved otherwise.  I thought perhaps it was the thermometer so I bought another one just to be sure.  Two thermometers cannot be wrong.  I was not paranoid. For a while I just chalked it up to a 24 hour virus.

someone forgot to tell her that she is supposed to be "sick"

This Mama Bear doesn't tend to rush The Chunky Chicken to the doctor at the first sign of fever.  I like to wait.  And wait.  And wait.  Yes, I avoid the pedi unless it is absolutely necessary.  I do not like doctor's offices (yeah, I know.  I went into the wrong field).  In the past 31 days, Ellie has experienced 7 different febrile episodes.  Seven.  Only one of them lasted more than 24 hours--it lasted the 3 days.  That was when I bucked up and took her to the PCP because she might be, you know, ill.  Ellie sauntered into the office with two baby dolls and her plastic stethoscope.  Both baby and Ellie's physical exam was baseline.  As in normal.  As in they couldn't find anything 'wrong' with her. They drew a CBC and it looked okay.  We were told to follow up with Infectious Disease [ID] if these fevers continued for 2 more weeks.  The Bear is and enigma.  Yay!

What do you do when the hoof beats are not horses?

You start to look for zebras.



Seeing as our pedi was at a total loss, I went to the best medical source possible--Facebook!  I got some great differential diagnoses and started to monitor Ellie's fevers more closely.  I got the idea to call her old allergist/immunologist who also referred us to ID.

When Ellie's fever return after 56 hours, I lost it.  I was actually stuck in the Austin airport for several and I mean several hours while trying to get to a wedding in St. Louis.  I had my iPad and a speedy Internet connection.  With too much time on my hands near gates 13-17, I consulted the best medical manual around--Google.   

In case anyone is wondering, if you type in "frequent fever Down syndrome" you get:

LEUKEMIA

When clearly my daughter really has malaria or nephrotic diabetes insipidus or PFAPA.

Which brings me to this important life lesson: avoid Googling!!!!!


Upon returning to Austin and reuniting with the my baby girl, I immediately set up an appointment with Infectious Disease. I was certain I would have to wait a few months but they worked us in for the next day. . . today.  I felt a bit ridiculous walking into the clinic today--yeah, my daughter has fevers but she looks great and acts great and seems perfectly healthy!  

Of course, this is the kid who once had coxsackie, a staph infection, and sinusitis all a the same time and was excitedly signing "play".  She is also the kiddo who got pneumonia while on an antibiotic. This kid rarely acts sick. 

Our visit went alot like this:

Dr: Does she have a cough or runny nose?

me: No 

Dr: Does she have any drainage from her ear tubes?

me: No

Dr: Does she have any swollen joints?

me: No

Dr: Any diarrhea or vomiting?

me: No

Dr:  any throat infections, problems breathing, runny nose, stuffy nose, foul smelling urine, swollen lymph nodes, stomach pain, throat pain, head pain, wounds that don't heal, or rashes, etc. etc. etc?

me: no, no, no, no, no, uh she is nonverbal and cannot tell me what, if anything hurts

Dr: Does she have any bruises or petechiae?

me: She always has some petechiae.  It really isn't impressive.  More like pressure petechiae, see? [I show the Doc her waist line and shoulders--areas where her waist band and seat-belt left petechiae]

Mild petechiae from laying on ear, tourniquet during blood draw, and crying/screaming

The physical exam goes like this:  normal, normal, normal, normal, normal, normal, hyperactive

This is all GOOD!!!!

Of course we went to Quizno's after her blood draw

The doctor leaves the room and comes back in with an list of labs to run--CBC with manual review, ESR, C-reactive Protean, all sorts of immunoglobin levels, strep pneumonia serotypes, uric acid, lactic acid, metabolic panel.  Essentially she is checking for inflammation and her antibodies.   The doctor is confident that based off of Ellie's physical exam and the CBC performed at the pedi's office last week that her fevers are not the result of something hematologic.  As in NOT a leukemia.  Whew!!!!  Happy dance.  She does think that these fevers could be immune-related. Oh goody [sarcasm].  It does make sense. . . I sort of forgot that Ellie had SNOT from January to April thanks to a monstrous sinus infection that just would not quit--hence the adenoidectomy.



Five vials of blood later, I have decided that my daughter's awesome physical exam and lack of symptoms point her to just being an "odd duck".  

A FB friend once told me that "every kid seems to have 'thing'".  Maybe these fevers are Ellie's "thing". 

I am grateful that she looks great.  I am.  Believe me.  Yet, I am peeing my pants over here with anxiety.