Q. Why do I have recurrent attacks of low-grade fever, muscle pain, and fatigue for 17 years?

Answered by
Dr. Bn Bhagat
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Dec 03, 2021

Hi doctor,

I am a 49-year-old man with a weight of 85 kilograms and a height of 1.84 meters. I have recurrent attacks of low-grade fever, muscle pain, fatigue, and insomnia, which have remained long-standing since seventeen years. The following laboratory tests including HIV, malarial parasite, complete blood count, fasting blood sugar, urinalysis, ultrasound scan, liver function test, hormonal profile (diagnosed the values of luteinizing hormone, follicle-stimulating hormone, free and total testosterone, sex hormone-binding globulin, dehydroepiandrosterone) are done. All these parameters turned out to be normal. My lipid profile also turned out normal. A consultant physician diagnosed me with chronic fatigue syndrome and placed me on an increasing dose of Coenzyme Q10. My problem persists relentlessly. Please help.



Welcome to

I have read your query. I am sorry for such discomfort you are having. You mention that the symptoms are very low-grade fever, muscle pain, fatigue, and insomnia. These symptoms present in remission and relapsing manner for seventeen years. Obviously, it is a very long-standing symptom with you. Chronic Fatigue Syndrome(CFS) is a very challenging condition to diagnose. It is diagnosed when other medical conditions fail to explain the patient's similar symptoms. Your treating physician must have ruled out other medical conditions identical to the above symptoms before diagnosing CFS. You have undergone a lot of investigations mentioned in the query, but all failed to diagnose your condition. Also, diagnosis of CFS requires core symptoms of fatigue and difficulty with memory, focus, and dizziness that worsen with the change of body posture.

Does your fatigue worsen with physical or mental exertion, and fatigue does not go away with adequate rest? There is no cure for CFS. The main aim of treatment is symptomatic. The most disabling or severe symptoms of the patient are addressed first. I do not know what is more bothersome for you. Lifestyle, proper sleep routine, and specific medication for disabling symptoms are usually aimed in the treatment. I would suggest you take symptomatic treatment for CFS by your doctor so that you can feel well. You may need counseling therapy too. Take Coenzyme Q10 in the prescribed dose and a multivitamin supplement. I hope you find this helpful. Take care. Thanks.

Thank you doctor,

Thanks for your timely response. I do not have any difficulty with memory or dizziness that worsens with body posture. My fatigue does not worsen by physical exertion, and I firmly believe that I am suffering from an undiagnosed illness. I need a proper diagnosis, particularly through recommended specific laboratory investigations. That battery of examinations yielded nothing and only made me feel miserable. I have the best brands of Coenzyme Q10 and reached the maximum recommended dose without satisfactory results. No stone was left unturned. HIV screening, hepatitis B, and C were all done.



Welcome back to

I am sorry and understand your condition. Usually, fatigue worsens with physical or mental exertion in CFS and is not alleviated by rest. There are specific diagnostic criteria for CFS in which the characteristic persistent or relapsing unexplained chronic fatigue is defined with other symptoms.

But you mention, you do not have such kind of fatigue or impaired memory or concentration. You can ask your consulting physician regarding it. For proper diagnosis, we need detailed medical history, physical examination, and then the relevant investigations are tailored to find the cause of your symptoms. You can try visiting another physician in your area to get help regarding your health (On online, it would be difficult for the doctor to formulate a proper differential diagnosis as we cannot do a physical examination, and there are other limitations also).

CFS has the following differential diagnosis:

• Depression.

• Anemia.

• Hypothyroidism.

• Adrenal Insufficiency.

• Celiac disease.

• MS (multiple sclerosis).

• POTS (postural tachycardia syndrome).

•OSA (obstructive sleep apnea). Now, specific investigations to be done need careful, detailed medical history and physical examination, which becomes easy on visiting the physician rather than doing online. I hope I can give you some help through our interaction. Thanks.

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