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What causes persistent fever, joint pain, and rash?

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What causes persistent fever, joint pain, and rash?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At December 8, 2016
Reviewed AtApril 26, 2024

Patient's Query

Hi doctor,

I have had a fever for over a year now. I have joint pain in wrists and awaiting ultrasound guided steroid injections. I have three deformed fingers, premature ventricular contractions, shortness of breath, chest pain, upper back pain, neck stiffness, cracking and pain. I have dry mouth, nose, throat, eyes and now choking regularly. I had surgery for a prolapsed spinal disc and loss of sensation or power to the entire right leg. Now, I have a rash on my face and neck and unexplained bruises and rashes. My joints crack and creak. My wrist and knuckles swell and turn red. I have ulcers in my mouth and lost weight. My BP keeps fluctuating between 69/49 mmHg and 220/202 mmHg and pulse too remains irregular between 39 bpm and 115 bpm. I also feel fatigue, irritability, aggressive with low vitamin B12. The rheumatologist, who I am visiting once in six months, is not keen to diagnose me. Please help me.

Hi doctor,

Welcome to icliniq.com.

Well, it does look like you are having an autoimmune problem. But, the type of rash, puffy fingers, rash over the knuckles, and fever does warrant that we should evaluate you further. Secondly dry eyes, dry mouth, and choking. That is a bit of concern as we need to see you do not have any other muscle weakness along with it goes on. Choking can happen due to dryness also or due to the involvement of the muscles. I am not sure if you are experiencing difficulty in climbing stairs or combing your hair. And, if there is a history of hair fall or oral ulcers. But, I am going to advise you on a few tests which you need to get done. From that, we will know the exact diagnosis and can start treatment before waiting any further. In case you have done these tests, then you can update me on the results.

Thank you.

Investigations to be done

1. ANA (antinuclear antibodies). 2. ENA profile (extractable nuclear antigen antibodies). 3. Complete blood count. 4. ESR (erythrocyte sedimentation rate). 5. Urine routine. 6. Liver function tests. 7. CPK (creatine phosphokinase) and LDH (lactate dehydrogenase).

Differential diagnosis

1. Lupus (inflammatory disease in which immune system attacks own tissues).

2, Dermatomyositis (skin rash, muscle inflammation and weakness).

Treatment plan

Avoid sun exposure for the time being.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Naval Mendiratta
Dr. Naval Mendiratta

Rheumatology

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