Integrative Medicine Case Reports, Volume 5, Issue 1 (January), 2024

A challenging case of pyrexia of unknown origin: the consequences of homeopathy intervention

Niharika Jain,^1* Neeta Jain,² Amit Kumar Jain³ and Simran Singh⁴

¹Central Council of Research for Homoeopathy, New Delhi, India
²Pt. Jawaharlal Nehru State Homoeopathic Medical College, Kanpur, India
³Department of Anesthesia, SSH-NSCBMC Jabalpur, India
⁴The Wellness Decoded clinic, Hyderabad, India

Introduction

The initially identified occurrence of pyrexia of ambiguous cause was reported in 1961. The term “pyrexia of unknown origin” (PUO) refers to a temperature of 101 degrees Fahrenheit or higher that persists for a minimum of three weeks without a definitive diagnosis despite investigations and admissions (1). As years passed, the PUO was further classified as Classic PUO (the most frequent observed), Nosomial PUO (related to drugs and healthcare), Neutropenic PUO (triggered by neutropenic deficiency) and HIV-related PUO (due to acute illnesses) (2).

Case Presentation

A 32-year-old male from India visited the OPD complaining of continuous fever for the preceding six months. His socio-
demographic data revealed that he was self-employed, from an urban joint family and had a post graduate degree.

STEP 1: Patient’s medical history

According to the patient, his problem manifested suddenly without any apparent cause. The patient started complaining that the constant high temperature was reaching almost 102°F–103°F. The heat was particularly intense in his palms, feet, and head. Alongside this, he experienced tremendous weakness and exhaustion, especially during work. Despite being on medication and taking high-strength anti-febrile tablets every two to three hours, his body had ceased reacting to them.

Step 2: Identify fever pattern

The fever comes every month between the 15th and 20th days. An understanding of different fever patterns is essential, They are (Figure 1):

Figure 1: Fever Patterning.

STEP 3: Examination and Investigations

A physical examination is key to any diagnosis. Look for systemic changes in the heart (murmurs, irregular heart sounds, and tachycardia), lungs (wheeze, rhonchi, and pleural rub), abdomen (splenomegaly, hepatomegaly), lymph nodes, skin rashes, and neurological reflexes (3).

On initial examination, he had tachycardia (100 beats per minute) and was febrile (102°F) with a blood pressure of 110/70 mm Hg. In systemic examinations, the cardiovascular, respiratory, GIT, and nervous systems were examined, and the findings were normal. The tongue had a milky white coat.

A comprehensive metabolic panel, analysis of urine with a microscope and culture, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) is standard points of departure for investigations (4).

The findings of every investigation, including the white blood cell count, liver function tests, and C-reactive protein, were normal. Results from the Widal test and malaria parasites were both negative.

Blood cultures (3 sets), Chest X-ray, serum creatinine, rheumatoid factor, tuberculin skin test, HIV immunoassay, CT abdomen and chest, and cardiac echocardiography. When all these investigations come up inconclusive, It is determined that the fever is pyrexia with an unidentified cause. The diagnosis is still uncertain despite the fact that he has had practically every relevant investigation, including the bone marrow biopsy, considered to be the most advanced investigation.

STEP 4: Mental and personal history

His traits include being stubborn, always getting his way, having a great desire to travel, being fastidious about keeping things tidy, experiencing mental suffering, and worrying about his health.

Appetite – loss of appetite, nauseating feeling, after food, there is no desire to eat.

Diet– vegetarian

Thirst – craving cold water during fever

Urine – normal

Stool – constipated, he has to strain a lot

Desire – cold things

Aversion – not specific

Thermals Reaction – chilly +++

Perspiration – Not specific

Sleep – He was anxious about his health, which was making it difficult for him to go asleep.

STEP 5: Treatment and Dosage

Important rubrics and repertories should be considered for homeopathic treatment.

Rubrics: (Figure 2)

CR21 – sleep; disturbed; anxiety, from (69)

CR21 – generalities; food and drinks; cold; food; desires (128)

CR21 – rectum; constipation; chronic (112)

CR21 – stool; hard (417)

CR21 – stomach; thirst; fever; during (252)

CR21 – mouth; white; milky (15)

CR21 – fever, heat; periodical (197)

CR21 – mind; obstinate, headstrong (213)

CR21 – mind; anxiety; health, about (304)

CR21 – stomach; appetite; diminished; fever, during (71)

CR21 – stomach; nausea; eating; after (279)

CR21 – mind; restlessness, nervousness; fever; during (62)

CR21 – mind; fastidious; work, in (4)

CR21 – generalities; weakness; fever; during (186)

Repertorization:

Figure 2: Repertorization Sheet.

Prescription:

Nux vomica 200 BD × 3 Days.

Reason for dosage: High symptom similarity has high susceptibility and that requires high dosage

Sac lac for 7 days.

For symptomatic treatments, clinically relevant remedies can be used, like:

Aconite: High temperatures, agitation, and intense demands require plenty of water. Face flushed due to the strong wind exposure. It is often administered early on as well.

Belladonna: No thirst, flushed the cheeks, a high temperature, and want for solitude. Carotid throbbing and a headache fever caused on by activity or sunlight exposure.

Arsenic album: Fever and restlessness constitute some of the symptoms. Weakness and genuflecting frequently drink small amounts of water. Extremely strong rigors and chills, with a feeling that the blood circulates like ice water. The patient feels like their blood vessels are being filled with boiling water during the heating stage.

Bryonia: A dry cough and fever, along with a widespread physical ache. Does not want to speak to anyone and wants to lie still. A constant need for enormous quantities of water.

Gelsemium: Aching starting at the nape of the neck, darkened face, and flushed countenance. The patient prefers to lay down quietly and has no desire to drink.

STEP 6: Follow ups (Table 1)

Table 1: Follow up schedule.

Once the individual has been deemed cured of PYREXIA OF UNKNOWN ORIGIN (PUO), the course of treatment will end.

Differential diagnosis

The causes of fever of unknown origin (FUO) can be grouped as infectious, non-infectious inflammatory disorders, malignancy, and miscellaneous, which include conditions such as thyrotoxicosis. All the possible causes in these categories that could potentially explain the clinical picture in this case, including rare ones, were considered and excluded following an intensive investigation (5).

Discussion

As we have seen in the case presentation, following these steps when treating a PUO makes the case taking systematic and the treatment coherent. This also helps the physician in the elimination process of fevers. Clinical understanding of fevers helps a homeopathic physician in better understanding of the case subject and in turn improves the process of analysis of case.

Conclusion

The above scenario emphasizes the potential benefits of homeopathy in handling episodes of PUO and sudden unforeseen events. After an appropriate amount of time has passed to rule out self-sustaining fevers, it is nevertheless challenging to figure out PUO despite a high-quality workup. The emergence of methods for molecular diagnostics has made it more feasible for a physician to capitalize on the medical records of the patient to distinguish infections from other medical conditions.

Authors’ contribution

AKJ: Contributed to conception and planned the article. NJ and SS: Implémentation & Design the article. NJ: writing, critical revision and planned the article.

All authors discussed the case report and contributed to the final manuscript, and they also agreed to take responsibility for all elements of it. This ensured that any questions about the accuracy or integrity of any portion of the work were thoroughly investigated and debated.

Informed consent form

Yes.

Source of funding

We have No funding sources.

Conflict of interest

None.

Received Date: 10-07-2023; Revised Date: 06-11-2023
Accepted Date: 14-11-2023

References

1. Beresford RW, Gosbell IB. Pyrexia of unknown origin: causes, investigation and management. Internal Medicine Journal. 2016 Sep;46(9):1011–6.

2. Hayakawa K, Ramasamy B, Chandrasekar PH. Fever of unknown origin: an evidence-based review. The American journal of the medical sciences. 2012 Oct 1;344(4):307–16.

3. Sepkowitz KA. Effect of prophylaxis on the clinical manifestations of AIDS-related opportunistic infections. Clinical infectious diseases. 1998 Apr 1;26(4):806–10.

4. Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, Smilde TJ, Krabbe PF, Oyen WJ, van der Meer JW. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine. 2007 Jan 1;86(1):26–38.

5. Cunha BA, Lortholary O, Cunha CB. Fever of unknown origin: a clinical approach. The American journal of medicine. 2015 Oct 1;128(10):1138-e1.