What causes recurrent fever and body pain in a 13-year-old?
Patient's Query
Hi doctor,
My son is 13 years old and his weight is 101 lbs. 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.
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.
- The recurrent infection could be due to low immunity secondary to malnutrition.
- In the HbE trait, the bone marrow functioning will be more due to mildly increased cell turnover, hence more nutrition is necessary. He will require a 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.
Patient's Query
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?
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 the abdomen. It was more than five years back, and so I think it would not be present.
- If it still persists, then a biopsy is necessary to identify any cause. However, as no other group of lymph nodes in the neck or other locations has enlarged or persisted till now, I strongly doubt those lymph nodes could be of any significance.
- The count of lymphocytes is mildly increased. If you notice the reports from one year earlier, lymphocytes were normal.
- Due to the changing climate, viral infection and low-grade nature might be there, which is causing a mild lymphocyte increase. This indicates a good immune response and should not be worrisome. If the lymphocytes increase above 90% and persist, 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.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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