[26F] Persistent low-grade fever and swollen lymph nodes

Patient Description

A 26-year-old female has been experiencing a persistent low-grade fever for two months, with temperatures typically around 99.5°F and occasionally reaching 100°F. The fevers tend to worsen slightly in the afternoon and evening. Initially, in October, she noticed a swollen cervical lymph node on the left side, which was painful at the time but is no longer tender and has persisted for four months. She also experienced painful swollen axillary lymph nodes, which have since resolved. The patient has been feeling fatigued but has not observed any weight changes, night sweats, rashes, joint pain, or rapid increase in lymph node size. She has tried managing the fever with Advil and Tylenol with little relief. She tested negative for Covid-19. The patient has a history of hypermobile Ehlers Danlos syndrome, diagnosed seven years ago. Her current medications include duloxetine, Vyvanse, propranolol, Midodrine, fludrocortisone, and Zofran. Additionally, she had a negative rapid mono test followed by a positive heterophile antibody test, but more specific Epstein-Barr virus antibodies were negative. She has a history of mono from eight years ago.

Arora's Assessment

What might be happening

Based on the information you provided, possible diagnoses include:

Mononucleosis: Also known as "mono" or the "kissing disease," this is a viral infection caused by the Epstein-Barr virus. It can cause symptoms such as fatigue, fever, and swollen lymph nodes. However, your test results for mono are somewhat conflicting, with a positive heterophile antibody test but negative Epstein-Barr virus antibodies. It's worth noting that these tests can sometimes yield false positives or negatives, and that you can get mono more than once, although it's rare.
Other Viral Infections: There are many viruses that can cause prolonged fever and swollen lymph nodes. These include cytomegalovirus (CMV), human immunodeficiency virus (HIV), and others.
Autoimmune Conditions: Conditions such as lupus or rheumatoid arthritis can cause prolonged fever and swollen lymph nodes. However, you didn't mention other common symptoms such as joint pain or rash.
Lymphoma: This is a type of cancer that starts in cells that are part of the body's immune system. The main symptom is usually a painless swelling in a lymph node. However, lymphoma is relatively rare and there are many more common causes of your symptoms.

What you can do

Given the duration and persistence of your symptoms, it's important to consult with a healthcare provider for a thorough evaluation. They may want to repeat some tests or do new ones.

In the meantime, continue to monitor your symptoms and take steps to manage your fever, such as:

Stay hydrated: Fever can cause fluid loss and dehydration, so drink water, juices, or broth.
Rest: Your body needs energy to fight an infection. Getting rest can help.
Dress lightly: Overdressing can trap body heat and make a fever last longer.

What you should look out for

Seek immediate medical attention if you:

Have a fever higher than 103 F (39.4 C)
Have a fever for more than two weeks
Experience unexplained weight loss
Have severe, unexplained fatigue
Have persistent, unexplained lymph node swelling

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care.

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11 mo ago

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[26F] Persistent low-grade fever and swollen lymph nodes

What might be happening

What you can do

What you should look out for

Experiencing symptoms?