Continuous fever with fluctuation in temperature, chills, fatigue, loss of appetite, stomach upset, very low sex drive. History of surgery for deviated septum. All tests normal. Help
Patient: My boyfriend is a 38 year old male who has had a fever between 99 and 104 for the past five weeks.  All blood tests, xrays, ct's, urine tests, and cultures etc have come back normal. He gets very shaky and has chills and tremors when his fever starts. He is usually healthy, but has had a history of sinus problems and had surgery on nose and sinuses 2-3 years ago to fix a deviated septum.  He has been getting weaker daily as his fever persists, huge lack of energy and tires quickly, has had a loss of appetite since the fever began and has lost 20 lbs or more from eating so little.  He's been going to the doctor and hospital for weeks, but the tests show nothing. His mom has sarcoidosis (sp?), an autoimmune disease I believe. He has occasional cough (not bad and stops quickly but not usual for him) and has had an stomach upset lately (bloating, heartburn, constipation), and he no longer wakes up sneezing 50 times every morning, as he has EVERY morning since his sinus surgery.  Not sure it's at all relevant, but he's had a very low sex drive for 15 years, which to me is extremely unusual.  After his late teens, he has had little interest in sex and often goes months without interest.  While single from 20-33 he went years without being sexually active at all.  He is the total opposite of any man I know this way, just placing a very low importance on anything related to sex, although he can be aroused and perform normally when he does occasionally feel obligated to force himself to get "in the mood".  Since the fever began, We have both done tons of reading online about possible diagnoses, but it seems to cause more questions and concerns, and no one can offer any answers and he can't his doctors to refer him to any specific type of specialist or anything, to figure out what could be wrong.  Where can he turn next for help? His family doctor and hospital doctors have no idea, and keep telling him to come back every couple days if fever persists, but it has and he is desperate for help.  Has missed a LOT of work from this and has not gone one day without a fever since it began. Doctor: Hi there ~After reading your history about your boyfriend, I believe that he has a chronic disease.  He needs to be checked out for a sexually transmitted disease profile as well as run a panel for autoimmune diseases.  A visit with a psychiatrist will be necessary to rule out bipolar disorder.  I wonder if an infectious disease specialist can also help along with an allergist/immunologist.  Please take all his previous investigations with you for these appointments.  I hope this helps.Take care and have a lovely day!