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Q. What could cause recurrent fever and body pain in a 13 year old?

Answered by
Dr. Prakash H. Muddegowda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 04, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

My son is 13 years old and his weight is 46 kg. His WBC is 6000, lymphocyte is around 50% (checked thrice in the last two years), Hb is 11 g% and HbE trait. His overall health is fine, but he is getting recurrent fever attack of around four to five times in a year with severe body pain. Please help.

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Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

  • HbE trait with 11 g% hemoglobin is good and well maintained.
  • His white blood cell count is normal and lymphocytes are mildly increased. There is nothing to suggest any particular cause.
  • Recurrent infection could be due to low immunity secondary to malnutrition.
  • In HbE trait, the bone marrow functioning will be more due to mildly increased cell turnover, hence more nutrition is necessary. He will require protein-rich diet along with a balanced diet. Maintenance of good hydration is also necessary.
  • Body pain could be due to infection or bone pain. Improved nutrition should help.
  • There is nothing to worry about lymphocytes. Do concentrate on improving nutrition.

For further information consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist

Thank you doctor,

In continuation to my earlier communication, I would like to give a brief health summary of my son along with some specific queries in this regard. His medical history records are as follows. When he was 7 years old, USG of abdomen showed mesenteric lymphadenopathy. The test repeated after one year and showed mesenteric lymphadenopathy and multiple enlarged lymph nodes at peri-umbilical region and right iliac fossa. I have attached the CBC report of the past five years. The CBC report shows Hb 11.7, WBC 6300, N 45, L 46, E 08, ESR 8 and CRP 4.3. Based on the same my queries are as follows. Mesenteric lymphadenopathy was persistent after one year. Do I need to follow up?  There is no abdominal discomfort at present. He has a persisent high lymphocyte count till date. Please advice regarding this. Kindly comment on his HPLC report. He is taking Folvite 5 mg daily for the last three years. Should he continue the same? Please check the attached CBC report. Also, what does reactive lymphocyte mean?

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Hi,

Welcome back to icliniq.com.

Based on your query and attached report (attachment removed to protect patient identity), my opinion is as follows.

  • Abdominal discomfort is usually not a presenting feature of enlarged lymph nodes in abdomen. It was more than five years back and so I think it would not be present.
  • If still persists, then a biopsy is necessary to identify any cause. However, as no other group of lymph nodes in neck or other locations enlarged or persistent till now, I strongly doubt those lymph nodes could be of any significance.
  • The count of lymphocytes is mildly increased. If you notice one year earlier reports, lymphocytes were normal.
  • Due to the changing climate, viral infection and low grade nature might be there, which is causing mild lymphocytes increase. This indicates a good immune response and should not be worrisome. If the lymphocytes increase above 90% and is persistent, then I would be worried.
  • Folvite (Folic acid) is not necessary if nutrition is good with eggs, chicken, fish, green leafy vegetables, etc. It is only a nutritional supplement. It can be discontinued. The kid needs to be on a balanced nutritional diet.
  • The report is correct for HbE trait. Usually hemoglobin in such conditions is around 11 and it is normal for this condition. It is being well maintained all around.
  • Reactive lymphocyte means lymphocytes increase due to stimulation like infection, etc. It is normal and nothing to worry.

For further information consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist



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