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Why do I get fever in the evenings?

Q: I am a 32 years old man having fever for the last two weeks with temperature less than 38 degree F. For the last five days I have fever only in the evenings with a temperature of 37.5 degree F. It is accompanied by headache and body and joint pain. The temperature comes down by itself to below 37 degree F by night, without taking Paracetamol. I underwent a blood test, which shows some lymphocytosis and an increase in C reactive protein to 14. I had a urine test too, which was normal except for occasional WBCs. I had a higher value of ALT (158) for, which I underwent an ultrasound, which revealed a fatty liver. Everything else is normal in the ultrasonic including normal paraaortic lymph nodes. Hepatitis A, B and C were negative and HIV was also negative and my salmonella and malarial smear were negative too. What should I do? Please advise.

A:The cause for most fevers can be diagnosed on the basis of presenting symptoms and a good physical examination accompanied by appropriate laboratory investigations. Most such episodes are self-limiting with viral illnesses like an upper respiratory tract infection being the most common. But these usually resolve in a fortnight. Fever persisting beyond this period, as in your case, requires extensive diagnostic work-up as, rarely, it could be due to a serious underlying disease. A large number of diseases can lead to prolonged fever. The likely causes include infection, collagen vascular disease, a malignant disorder or immune deficiency. Please consult an experienced general physician who can take a detailed history, give you a thorough physical examination and then follow-it up by relevant investigations. My listing out the names of conditions and laboratory or imaging investigations would not serve any useful purpose.

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