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Ask the Medical Expert Archives 2000-2004

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Chronic Fatigue Syndrome
June 2000

Q. I have had a low grade fever of unknown origin for three months. It never rises over 99.4 degrees, and sometimes, periodically throughout the day, I register a normal temperature. I have been feeling flushed and hot. I have had periodic headaches in the lower part of the back of my head. My glands are swollen, and I've been experiencing fatigue, and general malaise. I have had numerous blood tests (HIV, Hepatitis, Malaria, white cell count, red cell count, cdc, etc.) and all reveal that I am in perfect health. My doctor is at a loss as to what is causing this, and with the exception of the fever, believes that my mood may be contributing to this sickness (my mood prior to getting sick was better than I had been in a while). I got sick in February. From September to November of last year I was on Prozac. I am not certain of my dosage, but it was on the high side if I remember correctly. I stopped taking it in december because I didn't like the effects. Could there be a connection between my unexplained ailment now, and the prozac? Could you connect me with anyone who may have experienced this as well?

A. The definition of Fever of Unknown Origin (FUO) includes having a fever greater than or equal to 101 degrees on several occasions over at least a two week period without a clear cause. Therefore, by definition, you do not have a FUO due to your low grade temperature.

However, you do have a constellation of symptoms that could very well fit the criteria for Chronic Fatigue Syndrome (CFS) or Fibromyalgia. These syndromes are of unknown cause, although with CFS, a preceding viral illness is quite common.

In Fibromyalgia there are several "trigger point tenderness" in various areas of the body. There is on overlap of many symptoms in both CFS and Fibromyalgia and diagnosis can therefore be tricky. In CFS, patients experience severe fatigue over several months despite getting adequate rest. Other symptoms often include a low grade fever, sore throat, swollen glands, muscle and/or joint aches, headaches and depression.

Other illnesses that can cause similar symptoms need to be ruled out as evidently were done in your case. The prognosis is generally fair. Many patients are able to get at least some relief with various treatments.

In CFS, there is some data showing benefit from a medication called Sinequan. Sinequan is an antidepressant, but seems to give relief of many of the symptoms of CFS. The usual dose would be 25mg at bedtime. It may take several weeks to feel benefit with this drug. Anti-inflammatory meds such as Motrin or Naprosyn can alleviate various muscle aches and headaches. Good nutrition and a gradual exercise regimen also usually helps.

Unfortunately, some patients do not respond well despite the above, but most patients in my experience do at least improve with the above and often can return to a functional life including working and recreational activities.

I doubt that the Prozac that you took had any relation to the development of your symptoms. In fact there are some patients with CFS or Fibromyalgia that may benefit from a med such as Prozac.

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