07-25-2016, 08:19 PM   #1
xmdmom
Senior Member
Fever and Remicade

My son (23) just called. He is on Remicade for Crohns. He has a temp of 102 and had a headache yesterday and today for which he took tylenol. He didn't/doesn't feel terribly sick- he went to the gym after work. He didn't find out about the fever until this evening when he checked his temp because he felt chilly.

The on call GI told him if he has a fever in the a.m. to go to urgent care.
What do you do when you have a fever with Remicade? How soon should you be seen? Does the doctor usually do tests? If so, what?

It's his first (and hopefully last) fever on Remicade.

Thank you!
07-25-2016, 08:26 PM   #2
Clash
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My son only had fever on remicade once and it turned out to be the flu. His fever started out low grade but I think we went in to see the GP the day after his fever hit 102. The doc ran a quick strep and got a culture. I think he ran a CBC and the flu test. Told us to take in plenty of fluids and rest. Called the next day and said it was the flu. I'm trying to remember but I think we got Tamiflu and had to Chase down a pharmacy that wasn't out of stock.

I think it lasted about 5 days after the Dr visit but C never felt terrible.
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Clash
Mom to
C age 19
dx March 2012 CD

CURRENT MEDS: MTX injections, Stelara


Dx May 2014: JSpA
8/2014 ileocecectomy
9/2017 G tube

PAST MEDS: remicade, oral mtx, humira
07-25-2016, 08:49 PM   #3
my little penguin
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Ds has had multiple fevers over the years while on remicade or humira
Typically they do blood work- CBC mono adneovurus etc .., /strep test /check for ear infections and of bloodwork looks mostly ok watch
Ear infection - high fever then mastoiditis
Rest were strep or "virus" of unknown cause
We did have to check in a lot with his Ped and they set limits on how long he could have said fever
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07-26-2016, 10:10 AM   #4
xmdmom
Senior Member
So he went to urgent care-- no source of fever. Blood culture/cbc and cxray pending -- is it overkill or appropriate? IDK
07-26-2016, 10:55 AM   #5
my little penguin
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It typically
IF he has an infection then they have to know quickly
Plain and simple
CBC will let them know
As will X-ray and culture
Cultures take time so the sooner the better
If there isn't any infection then they need to know that as well
Good luck
07-26-2016, 11:37 AM   #6
Maya142
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That's pretty typical for a fever with no clear symptoms. Our GI told us she doesn't worry as much about fever that is associated with a regular kid infection -- such as strep. When there is fever without that, then she said you need to be worked up more carefully.

We were eventually sent to an infectious disease doctor before my daughter was cleared. She only had low-grade fevers (up to 100.4), but they still needed to make sure.

Good luck - will be thinking of your son.
__________________
Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
07-26-2016, 01:53 PM   #7
Tesscorm
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S has had fevers while on remi (flu, strep, bronchitis, etc.). All treated as they would have without remi (tylenol, abx, etc.). Did need to repeat abx once or twice to clear bronchitis.

I think blood/cbc pretty typical?? Did they hear any wheezing, etc? But, even without, because higher incidence of respiratory infection with remi, chest x-ray likely 'routine' in this circumstance (ie fever + remi).

And, agree, they will want to know cause of fever if it hasn't resolved and cause not clear.

Hope you hear back soon! The waiting is awful!
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Tess, mom to S
Diagnosed May 2011

Treatment:
May-July 2011 - 6 wks Exclusive EN via NG tube - 2000 ml/night, 1 wk IV Flagyl
July 2011-July 2013 - Supplemental EN via NG, 1000 ml/night, 5 nites/wk, Nexium, 40 mg
Feb. 2013-present - Remicade, 5 mg/kg every 6 wks
Supplements: 1-2 Boost shakes, D3 - 2000 IUs, Krill Oil
07-26-2016, 04:08 PM   #8
xmdmom
Senior Member
WBC 3.3 24% mono 47% neutrophil 1% band 28% lymph a few reactive lymph
28% lymph

....
ideas?
07-26-2016, 06:35 PM   #9
my little penguin
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Low WBC high neutro typically means virus for Ds
Hope you get answers
07-26-2016, 07:59 PM   #10
Switalski
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What about building up antibodies to the Remicade? When I did, I had a fever, chills, headaches and body aches.
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Diagnosed with Crohn's September, 2010
Right hemicolectomy April 4, 2012
Gall bladder removed February 16, 2015
Current meds: Humira
Adverse reaction to Remicade, but it worked
07-28-2016, 06:28 AM   #11
malorymug
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Yup. Looks viral. We have had 3 different experiences with fevers/crohns/Remicade in the last 6 months. We too, are asked to go somewhere else to find the source of the fever.

The first time he had fevers they started slow, low, and in the evenings. And I'm sorry to say, he has simmering disease resulting in fistulas and abscesses. It was remedied by increasing Remicade and he responded well.

The second time, he had the flu.

The third time (just a few weeks ago) we had reduced the Remicade dose resulting in fevers. But in order to come to that conclusion we had to see a doc that specializes in fevers and rule out everything else.

Good luck, I hope it is simple and resolves quickly.

__________________
Mom to: 15 year old boy
Crohn's in stomach, small intestine, large intestine, and perianal disease
Diagnosed April 2014, at age 13

Currently taking:
Remicade 10mg/kg every 6 wks
Methotrexate 7.5 mg/wk
Cipro
Augmentin
Miralax

previous meds:
6mp 50mg
Flagyl
Cipro
Prednisone 30 mg
07-28-2016, 08:42 AM   #12
xmdmom
Senior Member
He's better now! It was scary for both of us. I know serious infections are unusual but they do happen and it's difficult because he doesn't have a primary doctor where he is temporarily living and his GI doctor doesn't get involved with fevers.

I'm still worried about the WBC. It is low. He's not on an immunosuppressant.
07-28-2016, 09:14 AM   #13
my little penguin
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Remicade will drop the WBC as will a virus
Ds has had his low but the rechecked it a few weeks later no issues
Might ask your Gi if he can have it rechecked in a few weeks
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