A 33-year-old woman was admitted to our general medicine department with FUO which had persisted for longer than 2 months and was resistant to treatment with nonsteroidal anti-inflammatory drugs and prednisolone 20 mg/day. Her fever was remittent, and body temperature ranged from 37.5 C to 38.5 C. She reported sweating and headache, but did not complain of body weight change, pain, nausea, abnormal vaginal bleeding, or diarrhea.
To treat dysmenorrhea and premenstrual syndrome, she had been prescribed oral contraceptives (levonorgestrel, ethinylestradiol) for 7 years, and the dose had remained unchanged during that period. She had no history of pregnancy, and a gynecologic examination revealed no infectious or malignant findings.
She had been receiving regular follow-up care for mild depression for 3 years at our department of psychiatry and had been prescribed the antidepressants, aripiprazole and duloxetine hydrochloride, until 2 months before admission. Her depressive symptoms were stable upon presentation to our department. She had asthma, which was well controlled with the inhaled steroid budesonide (200 mug, once daily).
She was a housewife and only had sexual contact with her husband who had no sexually transmitted diseases. She had no pets and no animal or insect bites. She had not traveled for one year and had no history of drug abuse. A family history revealed no hereditary cause of fever.
Her height was 152 cm and body weight was 56 kg. Her mental status was alert, and blood pressure was 92/60 mmHg in a sitting position. Although the rise in body temperature was accompanied by an increase in pulse rate, her pulse was normal, ranging from 58 to 82 beats per minute. Her pulse rate was regular in rhythm, and its size, and tension were within the normal ranges. Her body temperature was 38.5 C and her respiratory rate was 15 per minute. Physical examination revealed no abnormalities, such as focal inflammation, lymph node swelling, skin rash, or abnormal heart sounds.
Laboratory analysis showed no biological inflammation C-reactive protein 0.0 mg/L, and interleukin-6 (2.1 pg/mL, normal range <4.0 pg/mL) and tumor necrosis factor-alpha (0.6 pg/mL, normal range 0.6-2.8 pg/mL) were normal. A chest X-ray showed no abnormal findings, and sputum culture for acid-fast bacteria was negative. In addition, an interferon-gamma release assay (QFT-2G, Oxford Immunotec Co, Ltd Oxford UK) was not positive (0.30 IU/L, normal range <0.80 IU/L). The results for the remaining biological tests were all in the normal ranges, as shown in Table 1. Contrast thoracic and abdominal computed tomography, brain magnetic resonance imaging, and gallium scintigraphy excluded infection, including tuberculosis, and rheumatic/inflammatory, neoplastic, or other focal abnormalities.
Fever decreased 2 days after adding Yokukan-san to 7.5 g of powdered OGT, which is the standard dose for adults (Figure 1). OGT was then prescribed for an additional 10 days, and fever has not relapsed after a follow-up period of 2 months.