What causes recurrent fever with high ESR and CRP levels?

Question

Hi doctor,

I have been experiencing a fever every day. The fever rises to a maximum of 100 degrees but then returns to normal body temperature without any medication. It is a repetitive cycle. I have undergone several blood tests and am attaching the reports.

I found that my CRP and ESR levels are very high (I have a history of aortic valve replacement surgery). I am concerned. Currently, I am taking Metoprolol 12.5 mg, Aspirin 75 mg, Warfarin 5 mg, and Atorvastatin, along with Fenofibrate.

Last week, I traveled out of town and had a significant amount of travel.

Kindly suggest.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

It is likely a viral fever, as it resolves within four to five days. ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are often elevated due to viral fevers or other types of fever. Since it recovers within four to five days without the need for antibiotics, it is most likely viral, and the possibility of other infections, such as infective endocarditis, typhoid, or malaria, becomes less likely.

Therefore, there is no need to worry. Repeated viral fevers can occur with travel, changes in environment, or changes in food, and the body typically clears them successfully. So, there is nothing to be concerned about. However, since you have had an aortic valve replacement, we need to be vigilant about the possibility of infective endocarditis.

You should have your ESR and CRP tested again in two weeks, and if they remain elevated, you should undergo an echocardiogram to rule out infective endocarditis.

I hope this helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

It seems to be a viral fever, as it has persisted for a week. However, it needs to be evaluated further. We need to rule out typhoid fever and infective endocarditis. You should have some blood tests done, such as the Widal test for typhoid, an echocardiogram for infective endocarditis, and tests for malaria and dengue NS1 (nonstructural protein 1).

You can have these tests done at any private laboratory, but the echocardiogram should be performed by a cardiologist, as it can be difficult to detect infection on a prosthetic valve. You may take a paracetamol tablet if needed.

Kind regards.