Viral Fever With Headaches At The Vertex And Neck. Has Autoimmune Thyroid Disease. Only On Paracetamol, Okay?

Posted on Wed, 28 Dec 2011

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 28 Dec 2011 Answered on

Wed, 20 Jun 2012 Last reviewed on

Question : Hi, my wife is suffering from viral fever (mostly) for the last 10 days with headaches at vertex and upper part of neck. Fever ranges upto 101 F. First 3 days paracetamol 650 mg was taken whenever there was headache and fever. From 4th day onwards she was started on Cefpodoxime 200 mg with Clavulanic acid 125 mg B.D for 5 days. Widal done on 9th day is negative. Her haemogram shows Hb 11.6%. She has autoimmune thyroid disease for last 20 years and she is on Thyroxin 50 mcg for last 7 years which has probably produced Leucopenia ranging from 2600-3400 through this period. Now with this fever W.B.C count has risen to 4700. Rest of the things are normal. Sr. Bilirubin is normal. Urine normal. ESR is 60. Now she is taking only paracetamol when required. Please advise.

Answered by Dr. Shiva Kumar R (1 hour later)

Hello.

Thanks for the query.

Though most viral fevers cause generalized myalgia, presence of headache and neck pain one should consider the possibility of asceptic or viral meningitis. Meningitis is inflammation of the leptomeninges as a manifestation of central nervous system (CNS) infection. In uncomplicated viral meningitis, the clinical course is usually self-limited, with complete recovery in 7-10 days.

The bottom line is that you need to XXXXXXX your GP for a good physical examination and to look for physical signs of meningitis. High index of suspicion is required for accurate diagnosis and management in such cases. One has to also consider other pathogens, such as bacteria (pyogenic) as the cause if some one has high fevers.

So I personally feel a good physical evaluation is required in you and if suspicious of neuroinfection you require additional tests like lumbar puncture and head scan. CSF examination is the most important test in differentiating the cause of meningitis. Prior to lumbar puncture (LP), a computed tomography (CT) scan should be performed in patients with any abnormal neurologic sign, to exclude an intracranial lesion or obstructive hydrocephalus.

I thank you again for submitting the query. If you have any additional concerns, I will be available for follow up query.

Please accept my answer in case you have no follow up queries.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist

Above answer was peer-reviewed by : Dr. Jyoti Patil