Clinical Cases

A Case of Pyrexia of Unknown Origin

shah nov

Dr. Krutik Shah presents a case of a child with fever of unknown origin.

A child 4½ yrs old came to me with her parents. There was no problem till she was two years old. She was born with the normal delivery. She had a wt. of 21/2 Kgs at birth and then it has increased steadily. She is suffering from cough on and off but no medicines have been given so far till now. This is mostly seen at the time of change of weather.

She has some problem regarding speech. This started mostly at the same time with this fever problem. She is repeating some words, like if she wants to speak “mummy” then she will do mmmm…mmmm…mummy (+3). There is no specific word or time with which she has a problem. Some words she repeats up to 10 – 12 times. This is also a problem for her but now we have observed that her style of speech has changed – now she takes a deep breadth and then speaks.

 

Parent’s Report

She has a fever since the last 10 months. It is coming every month between the 11th – 15th of every month (+3). Fever intensity is very severe. The body becomes so hot that we even cannot touch the body. We have observed that she might be playing well till the evening and as soon as night starts – her body starts getting heated up. We have observed that the fever is coming in the nights (+3). We must do cold water massage on the body for the whole night used to give double doses of paracetamol syrup but still that fever does not go at all. Fever is reaching almost 104 F. Fever becomes absolutely normal in the day whether we give the medicine in the night or not! We are really having troublesome time with our child between 11th – 15th of every month.

We have gone to three pediatric physicians and we have undergone almost all the relevant investigations including bone marrow biopsy, which is the highest level investigation and the diagnosis is still obscured. All pediatric physicians are saying that our child is suffering from “Pyrexia of Unknown Origin (P.U.O.)” We have spent minimum 120,000 Rs. for our child but still we have not been able to get her out of this problem.

She also has a whitish discoloration on face (+2). These discolorations are more on cheeks. It was there in the past but it was almost cleared with anti-worm treatment. Now it is coming back again. These are increasing day by day. She is suffering from worms on and off and we have given treatment for it three times.

She is also suffering from constipation. She has a hard stool (+3). She has to strain a lot. She is suffering from little loose stool since last two days. She has a pain in abdomen and then she goes for the stool. She had some diarrhea at the time of dentition. At that time – we had taken Homeopathic treatment along with Calcium & Vitamins as a supplementation.

She is by nature a very stubborn child (+2). She always does as per her wish. Whatever, we do to convince her – she won’t be doing. If you don’t do as per her wish, then she will go in the corner and cry constantly. She desires to travel very much. If you take her for traveling – then she will forget everything., she won’t even demand to eat, drink, etc. When she goes to the bathroom – she will take 30 minutes for her bath as she washes herself with soap for so long that we sometimes get offended upon her. She is regularly taking this much time. She knows everything where things have been kept. Sometimes she tells us that Daddy. you have put this thing here. She does her work on her own. Sometimes – she helps me in my work like sweeping the room, cleaning the utensils etc. Sometimes we even don’t know a thing where we have kept it but she knows and says “Mummy it is been put there”. She finds the cloths on her own that she wants to wear. She can match her cloths well. Even the ring for her hair she matches as per her cloths. She has a very high grasping power.

She wants to speak constantly. She picks up a word from our talk and speaks or sings upon it which is her regular habit. She speaks minimum up to 5 minutes upon that topic and then her mind gets diverted and then she forgets about it. She is very mischievous at home and she is quiet outside. She doesn’t love toys much. She can speak from 1 to 30, A to Z & Jan to Dec. even though she is just 4½ years old. She is very curious for her studies; she tells us that she needs to study. She does all her homework perfectly well.

She has no problem regarding food. She eats everything. She has no like/ no dislike for any food. One thing I forgot to tell you is that she likes milk (+2). But it is dependant upon her mood. If she has taken it at 8 o’ clock then she may demand it at 10 o’ clock. She does not take much but she takes it regularly.

 

PERSONAL HISTORY:

Appettite: Good. She cannot tolerate hunger. If she is hungry then she won’t be able to wait for half an hour! When she was two years old – she was regularly waking up in the night and wanted to eat. She can go to the kitchen and eat on her own alone. She has no fear whatsoever.

Thirst: – Very much. (+3)

Urine: – Normal. No bed wetting.

Stool: – Constipated. She has to strain a lot.

Desire/Aversion: – D: Banana (+2), D: Ice cream (+2). A: Not Specific.

Hot / Chilly: – Hot (+3).

Perspiration: – Very much.

Perspiration on neck and sholders during sleep (+2).

Talking during sleep (+2).

Sleep: – Good. No fixed Position.

Vaccination: – Done. No after effects.

Mile Stones: – Normal.

 

PAST HISTORY: – No new information found other then what is explained.

 

FAMILY HISTORY: –

Father: NAD.

Mother: – Ganglion Wrist, under my treatment.

 

GENERAL EXAMINATION: –

Built: – Good.

Nutrition: – Good.

Nails: – NAD.

Tongue: – White coated.

Mouth: – NAD.

 

SYSTEMIC EXAMINATION: – NAD

 

BIRTH HISTORY: – Not Specific

 

NOTE: – The case was taken on 10 – 7 – 12. I had observed that the child was very silent during the whole process of case taking. Her mother has given maximum information about her.

 

REPERTORIZATION CHART: –

 shah-nov14-01

 

PRESCRIPTON

  • Sulphur 200/one dose
  • L. B.D.S. for a week.

Sulphur 200 (SOS in case of Fever)

 

FOLLOW UP -1

  • Date: 16-7-12

Fever Low grade.

Feel better.

Comment: Remedy has acted as the child did not develop fever which used to come between 10th – 15th of every month.

  • Treatment: – S.L. BDS for a week.

 

FOLLOW UP -2

  • Date: 21-7-12

No major complaint.

Cough +. Not that much.

Comment: Good Sign!

  • Treatment: – S.L. BDS for a week.

 

FOLLOW UP – 3

  • Date: 29-7-012

No major complaint.

No cough. It subsided on its own.

Comment: Sign of elimination of Toxins?

Hahnemann has written that there are four methods of elimination of toxins from the body: – PERSPIRATION, URINATION, DEFECATION & RESPIRATION.

  • Treatment: – S.L. BDS for a week.

FOLLOW UP – 4

  • Date: 6-8-012

No major Complaints.

No Cough.

  • Treatment: – S.L. BDS for a week.

 

FOLLOW UP -5

  • Date: 11-8-12.

No fever.

No Major Complaints.

  • Treatment: – S.L. BDS for a week.

 

FOLLOW UP -6

  • Date: 19-8-12.

No fever.

No Major Complaints.

  • Treatment: – S.L. BDS for a 2 weeks.

 

FOLLOW UP -7

  • Date: 1-9-12.

No fever.

No Major Complaints.

  • Treatment: – S.L. BDS for a 2 weeks.

 

FOLLOW UP -8

  • Date: 19-9-12.

No fever.

No Major Complaints.

  • Treatment: – S.L. BDS for a 2 weeks.

As there was no fever since the start of the medication – it is a clear sign that the medicine has acted very well and it has almost cleared the problem. The child will be observed for 2 month more.

 

FOLLOW UP -9

  • Date: 4-11-12.

No fever.

No Major Complaints.

  • Treatment: – No medicine given.

 

FOLLOW UP -10

  • Date: 21- 11 -12.

No fever.

No Major Complaints.

  • Treatment: – No medicine given.

 

The treatment will cease as the child has been declared cured from the Pyrexia of Unknown Origin (P.U.O.). The parents are advised to consult the same pediatrician who diagnosed her and who has now declared her cured.

 

COMMENT:

  • This is a classic case of Intermittent Fever (Organon Paragraphs 235 – 244).

The indicated remedy should be given in the decline phase of a febrile state but due to mistake, I gave it at the beginning of an intermittent fever. However, luckily – it didn’t act in the opposite way but it has cut short the time, intensity as well as suffering of the patient.

  • Aphorism 242 of Hahnemann’s Organon of Medicine (5th Edition), says that “We have now to do with a Psoric intermittent fever only, and this will generally be subdued by minute and rarely repeated doses of Sulphur or Hepar Sulphuris in a high potency.”

This Aphorism ultimately helped me to clear this case.

About the author

Krutik Shah

Krutik Shah

Dr. Krutik Shah M.D. (Hom.) is the Creator of Gujarat State’s first private computerized “Shree Sai Homeopathic Hospital” which is the largest and most modern in the state of Gujarat. He is a Post Graduate from the International Academy of Classical Homeopathy and a Coordinator of their E – Learning Program for India. He is involved in research projects on pathological prescribing, Cancer, HIV and AIDS. www.drkrutikshah.com

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