It all started on the 1st of Nov on the Diwali (Indian festival) day. My wife had some work in her hospital for about two hours. We finished that and dropped in at a deaf and dumb rehab center and shared sweets and crackers with the children there for an hour. Soon after that, I had severe headache and rushed home and slept in the afternoon, which is quite unlikely of me. When I woke up in the evening, I had 101 degrees and a pounding heading.
We started treatment at home since both my wife and my mother-in-law are doctors. On Nov 2nd my temp peak was 102 degrees. And by the 4th of Nov the peak touched 103.5 degrees. This fever used to come down in the mornings and slowly rise during the day, reach its peak in the evening, stay till mid night and then start to fall. I also had severe hammering headache for every heartbeat.
By then, we had given blood samples to rule out all the common causes for this kind of fever, but unfortunately the results were all negative and did not contribute to a diagnosis. Then we got another general practitioner to come home and have a look at me. Since all my symptoms seemed more like Typhoid, she started me on oral antibiotics for it (T.Ofloxacin).
There was no improvement even after 3 days of this medicine when both families started to panic, as it was now 8 days of fever already. Then we decided to get hospitalized as the temp was not coming down and the fever pattern had also changed with multiple peaks in a single day with some of them even in the middle of the night.
Got admitted on the 9th day in Hospital. The Doctor who examined me there also only suspected typhoid and he concluded that it was resistant to the oral drug that I was taking and told me that I would need a more powerful intra-venous (I.V) antibiotic. He also asked for an infectious diseases specialist to have a look at me who thought that the dose of the I.V antibiotic might have to be stepped up to 3g (from 2g) which is the highest permissible dose. In the meantime, they did some more blood investigations, which also proved to be non-contributory.
On the 12th day, my fever was still rising, and the peak now was about 104.2 degrees. The doctors wanted to proceed to the next level of investigation, as they could not understand why my fever was still not coming down. Since they were only clinically suspecting typhoid and could not prove even that with investigations, they wanted to do a CT scan of the chest and abdomen to see for any focus of TB or to look for any hidden abscesses. But when the CT results also came as normal study, they wanted to do a bone marrow study as they thought that that was the last hope for them to obtain a diagnosis for my fever. So, they did a bone marrow biopsy on the 18th day of fever.
Now, bone marrow biopsy is a very painful procedure and even the doctors felt bad that it had come to this level. But luckily, this hospital happened to have the best hematologist in town as their consultant. This person is so busy that he works in a lot of places during the day and comes to hospital only late in the nights.
He came and examined me that night and told me that he would be doing the procedure the next night. On the 19th of Nov, when the hematologist came into my room in the night with scrubbed hands, I started to sweat with fear. He gave me some local anesthesia and started drilling into my hipbone. He kept talking to me the whole time to keep me distracted. But there was one point when he stopped and said,
“Sunil, I am sorry, at this point even I can’t help the pain that you are about to experience”.
I clenched my teeth, kept praying in my heart and was waiting for the pain when the doctor said that the procedure was over and that I’ve been extremely co-operative. I know for sure that God touched me at that moment, as I hadn’t felt the slightest pain yet.
The next morning, they decided to empirically treat me for malaria while they were waiting for the bone marrow biopsy a result (which normally takes about 3-4 days). In our country they are justified in using anti-malarial drugs for any resistant fever even if it is not proven to be malaria. They also wanted to start me on another antibiotic (T.Doxycycline) which would cover a few conditions like Leptospirosis or tick-borne fevers (I have a dog at home) which may not be very easy to prove with investigations. They stopped the I.V antibiotic, as I had showed no improvement at all with that.
They discussed my case at a clinical meeting with other physicians who had a lot of new suggestions. Some said that I should undergo a lumbar puncture to rule out meningitis. Some said that they should blindly use steroids at least to bring down the temp, while some others said that they should use T.Chloramphenicol – which is a drug with a danger of causing a serious complication called aplastic anemia in some patients, but very effective against typhoid.
Though my doctor patiently listened to all their suggestions, his decision was only to wait until the bone marrow biopsy results were ready. It was at this point (21st day of fever) when there was some sign of improvement. Though the bone marrow results also did not show any abnormality, the temp peak started coming down slowly.
It was definitely God who gave my physician the right discretion to wait and not hurry with further harmful medication. At this point they repeated a basic blood test to check for any rising titres and found that a test by name, Paul-Bunnel which was negative earlier showed some insignificant positivity. Though insignificant, since a test which was negative earlier was now turning positive, the infectious diseases specialist wanted to do a more specific test for the same disease that the other test was meant to diagnose.
So, they took blood for a test called IgM VCA on the 22nd day. By now, I had become very weak and had pain in my legs even if I walked a little bit. On the 23rd day since the temp peak was only 100 and since I was only taking oral medication, the doctors decided to discharge me saying that there was nothing more that they can do than to just wait for the temp to touch the baseline. They said that I could collect the IgM VCA reports as outpatient (OP), which was due in another 3 days and come for a review.
Two days after discharge, the temp touched base line. We collected the report the next day and were surprised to see that the report was strongly positive. A titre 12 is considered positive for this test and my titre was actually 150.
So, we finally had a diagnosis!
I was actually suffering from Infectious Mononucleosis. The presentation of this disease is usually with sore throat, enlarged lymph nodes and an enlarged spleen together with fever. Since, I did not have any of the other symptoms, other than fever; my case was very atypical making it very difficult for the doctors to diagnose.
Now, Infectious Mononucleosis is a disease caused by a virus called Ebstein-Barr virus. But in tropical countries like India, the virus is usually acquired during childhood. The virus is spread by person-to-person contact, via saliva – on hands or toys or by kissing (careful while kissing a baby next time). A person with “mono” can also pass the disease by coughing or sneezing, causing small droplets of infected saliva and/or mucous to be suspended in the air which can be inhaled by others. Sharing food or beverages from the same container or utensil can also transfer the virus from one person to another.
About 95% of healthy adults carry the virus in their saliva and are responsible for person-to-person transmission of the virus. Though most people carry the virus, only a few get this infection, which is due to the reactivation of the virus when a person’s immunity goes down. This disease is a self-limiting illness, which means that none of the antibiotics were actually helpful in curing the fever. The only thing I have to do at this point in time is to have a lot of rest as the virus can generally cause a lot of fatigue which remains even after the temp reaches the baseline.
By God’s grace and with prayers of many, my temp touched normal on the 24th day. Today, I feel weak but am sure recovering fast. I have been advised to have normal diet avoiding fatty food alone as my liver enzymes are a little elevated and will take some time before it returns to normal.
Praise the Lord!