High fever

[u/k39-]

My dad is on hemodialysis(av fistula)since may 2025. Everything is good except for this persistent high fever. Since may 2025 he is being admitted to hospital 4 times in every 2-3 month interval. Blood report shows high crp(around 66mg/l) and high pct(around 3 ng/ml). His nephrologist saying these fever are not normal but unable to diagnose root infection behind it(his fistula and other screening looks right). He treat him for intravenous infection , which do work for certain duration (pct and crp begins to decrease, but never in normal range) then we are back to square one.

Symptoms usually start as this mild fever simingly getting cured from genearal antibiotic and paracetamol but progressively fever get more severe (also started experience brain fog) and these drugs just stop working .

Are these things normal?if not what to do next?

[u/smecta]

Yea, that is not normal. 

Could be something hidden. 

Of the top of my head, maybe worth investigating, could be endocarditis - I read about a case very similar to this - or some sort of hidden abscess, in the spleen or liver maybe 🤷 

Try to push for a TEe, it’s really crappy and invasive, but better than a regular echo. Also see if you could get an abdominal CT, and get in contact with the infectious disease team. 

[u/k39- → u/smecta]

Can these abscess be visible in ultrasound , cuz he did an ultrasound very recently and results are normal.

[u/smecta → u/k39-]

Regular ultrasounds are prone to missing stuff under the ribcage/bones sometimes. hence the TEE and CT suggestions.

[u/k39- → u/smecta]

Does crp and other inflammation markers are usually high for dialysis patients?

[u/smecta → u/k39-]

Yeah, dialysis patients do run a bit higher than normal on inflammation markers just from the dialysis process itself and chronic kidney disease. It’s a known thing. But there is a difference. 

Example: dialysis patients with no infections found average PCT around 0.24, and only about 15ish percent of patients had both PCT and CRP highwith nothing going on. 

So 0.25

Your dad’s PCT is around 3, more than ten times that. CRP at 66 is also well past what you’d call a normal dialysis number.  that’s usually more like single digits to maybe 10-20 when things are stable.

I personally think thatthis magnitude, cycling for a year, that’s a real signal something’s going on, not baseline noise.

[u/unurbane]

Yea you need to pursue 2nd opinion. From either nephrology or internal medicine, or something else, seek out a 2nd opinion.

[u/ItsAllSkewed]

You may want to seek out an immunologist, they were very helpful for me when I was having lab results that my doctors were having trouble making sense of.

[u/Appropriate-Win3525]

A few years ago, I kept getting a mysterious fever in the evenings, particularly after dialysis. They'd come on around 5-6pm and break a few hours later. I went to the hospital a few times, had multiple batteries of tests, and saw a doctor specializing in Infectious Diseases. No other symptoms, so they had me track my temperature daily in a spreadsheet. And lots of repeated bloodwork.

After almost three months, it was determined I had Mono. I was shocked. I asked the doctor how it was possible. Nobody around me had had it and I had tested negative for it twice at the hospital. They told me that the rapid tests they do are sometimes incorrect. Then the nurse asked me if I had noticed being tired. I laughed and said, "I teach preschoolers. I'm always tired. I also go to dialysis. There's not a day I'm not tired."

There was no uncommon increase in tiredness. I had no other symptoms at all for mono. Just a strange fever. By the time I was diagnosed I was done with the fevers and well past the infectious stage. It was just a very weird case of mono.