I have been having sub-clinical body temperature for a month now.Over
the last 10 days I dont feel like eating and have persistent nausea and
vertigo. I also find it difficult to breathe manytimes. Have undergone following
tests that are all normal:
serum cortisol
TSH
haemogram
abdominal ultrasound
LFT
RFT
Urine test

need your guidance

Dr. Joshua’s Answer:

A thorough history and clinical examination are key, as always. Also, it would be helpful to know exactly what sort of temperatures we’re talking about. Keep a diary of measurements at different times of day. Without knowing your sex, age, or where you are from, I can only give some general lab and radiology recommendations.

Apart from that, some suggestions: Additional labwork that could be informative: CBC (complete blood count), CRP, ESR, HIV, virus package including cytomegalovirus, parainfluenza, measles, adenovirus, herpes, borrelia, epstein-barr. Also consider paranasal sinus X-ray, orthopantomogram, chest X-ray. If nausea and vertigo are the main symptoms, a clinical neurological examination is important, and possibly cerebrospinal fluid sample (spinal tap), with virus PCR to rule out viral meningitis

These are just general suggestions. The most important thing, as I said, is thorough history and clinical examination. The examining physician will then order lab and radiology based on the clinical findings or lack thereof.

If there is no diagnosis, or you don’t have access to these investigations, consider 2-week course of wide-spectrum antibiotic treatment and/or cortisone treatment. Usually this is not recommended without a definite diagnosis.

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