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No One Knows What It Is !
Jul 19, 2000

My other half is 45 yrs old, positive since at least 1985. He went on meds 5 yrs ago, now due to the way treatment was given is now resistant to all that is available but combivir. In the last 2 weeks he has developed severe headaches and fevers of which both have increased since the start. We've been to his dr. twice now and given no explanation, just "don't worry about it , I don't feel it's serious!" Now his fevers, which continue, have hit 103 and he cries due to the terrible headaches. He is someone who has a very high tolerance for pain. We went to the emergency room, they ran all labs, full body CT and did a spinal tap. THEY FOUND NOTHING! his diagnosis is "fever, unknown origin" and "headaches of unknown origin." So they send him home, because they couldn't find anything wrong. Dr. said "something is there, but we don't know what it is!" Could you please give me any thoughts you may have? His CD4 is 450 and his V-load is less than 50. I feel like I am watching the start of the end, and it's killing us both! Thank you,

Response from Dr. Feinberg

I find it hard to believe that a fever of 103 for over 2 weeks is "not serious". It is possible that enough information hasn't surfaced or been looked for specifically yet to make a diagnosis. Sometimes a head CT will not give enough information to make a diagnosis of sinusitis, for example, but occult sinusitis could cause a high fever and headache, even in a patient with undetectable viral load and good T cells. Another possibility in someone with good T cells is that his symptoms are being caused by an inflammatory process, like vasculitis, that isn't also an infectious process. Has he had a "sed rate" done? Is it normal? Blood cultures, including fungal and mycobacterial? How recently has his T cell count increased? Some people develop "immune reconstitution syndromes", which can include fever and other symptoms because an OI is brewing and suddenly a person's immune system improves, attacks the germ with enthusiasm, and sets off a significant inflammatory response. If the situation is as you describe, I would persist even if that means getting a second opinion. There are clues in the physical exam, so this is not something we can solve over the Internet. Don't give in to despair, and good luck!

Kaposi's Sarcoma

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