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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31322
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have had chills and cold sweats for about two years now.

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I have had chills and cold sweats for about two years now. I have had a postive test for autoimmune disease but my Ruematologist can't seem to pinpoint which one. I'm either freezing and sweating or hot and sweating but always have the chills. My temperature is always 97.7. I dont remember the last time I had a fever or a temperature over 100.0. I cant seem to gain weight and have been celebate for ten years with three AIDS tests done in the last five years. Also I am not Homosexual. I have genital Herpes that used to break out once in a while, but lately when the Herpes comes on I dont get sores or itching, instead I get some sort of gland swelling and pain in my groin area. I am A 54 year old male and have had over 30 surgeries from an on duty injury to my right leg and both shoulders. I've had my appendix and tonsils removed at 15 years old. I had bilateral hernia repair at 40 years old and have had tests to rule out Myasthenia Gravis, ALS and other nervous system disorders. I take 1mg of Ativan 3x daily at 8 hour intervals. I also take Trazadone 100 mg at bedtime for sleep and pain. I now have developed some sort of small wart to tag on my anus that is painful. My GP told me not to worry about it. I seem to have a sore epydidamuin my left testicle and CT revealed a moderate hydrocele. I am never comfortable cause I sweat all the time with chills at the same time. I am an avid athlete and have always been in great physical condition. Something is very wrong and my GP doesn't seem concerned. He tells me every visit that I am just depressed and Im getting very tired of hearing this. Any idea what could be the culprite or where I should start? Please help.......Sincerely, XMOTORCOP1

I am sorry that your question was unanswered for long.

What autoimmune tests were positive?
Did you consider a second opinion by another rheumatologist?
What did your peripheral blood smear, and PPD test show?
Were any medical imaging like CT scan of chest and MRI of abdomen done?

Dr. Arun
Customer: replied 3 years ago.

CT of chest reveald emphysema ( moderate). I have seen three Rhuemys and two fo them think I may have lupus. Anti DNA (DS) Ab Qn was 26, ANA direct was positive abnormal, ACE was 86 high, And sed rate has never been over 3, CCP anitbodies were 49 High, h-pylori Negative. Dont see where PPD was done on my tests. CT abdomen was normal one year ago.

Hello Lynn,


Following causes may be considered;


1) Mycobacterial infections
2) Medications
3) Gastroesophageal reflux disease
4) Sleep apnea
5) Idiopathic hyperhidrosis
6) Autonomic neuropathy
7) Carcinoid syndrome.


Investigations needed are;

1) a PPD test, peripheral blood film and blood cultures.
2) a bone marrow biopsy.
4) a 24-hour urine collection for 5-HIAA, metanephrines, and catecholamines

I am not sure what were the reason given for not starting the treatment for Lupus (medications for autoimmune disorders). Many times, the tests for the autoimmune disorders are not classical but with your symptoms and few investigations being abnormal, a trial of anti rheumatic drugs should be given to see the response and if those medications resolve your symptoms. This is called as therapeutic trial and therapeutic diagnosis. This is done when a clear diagnosis is not established and thus treatment of the closest diagnosis is started. If a 6 weeks trial does not cause resolution of the symptoms, you may consider consulting a infectious disease specialist. PPD test is for tuberculosis and mycobacterial infection. Mycobacterial infection has subtle symptoms and again, many times there are no clear investigations to establish the diagnosis. But it can present with your symptoms and raised ESR. PPD test usually is positive and a good indicator of starting the treatment.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.


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Customer: replied 3 years ago.

I dont' like the idea of taking treatment for anything Im not sure I have, until further testing has been performed to rule out infections. My family has a history of cancer and I am afraid to supress the immune system too much. When I use valacyclovir to treat the herpes my kidneys seem to suffer and my eGFR drops to 50. It goes back up when I get of the acyclovir. I dont have GERD or sleep apnea but last year I was feeling really down and sweaty all the time, blood was taken and the only thing it showed was EOS was high at 0.5 antibiotics were given and my symptoms improved for about two months. I am allergic to Flouroquiolones, but it seems to feel like some kind of smoldering infection that never goes away or some kind of virus that isn't running out. Any other ideas? I will have the PPD and blood cultures done ASAP. Also I am not a smoker but I have lately been coughing up some greasy black sputum but my GP didn't wat to take a sputum sample.


I agree that with a transient improvement with the antibiotic; a low grade chronic infection is the likely possibility and the culture tests (bacterial, viral and fungal ) and PPD are likely to help in the diagnosis. A sputum culture too would be good idea.

It is privilege assisting you.

Dr. Arun

Customer: replied 3 years ago.

Thank you very much I will do my best to get in tomorrow and have these tests taken, although my doctor doesnt seem to care for me trying to tell him what tests I want to have done. I sure do appreciate your time and honesty. Have a great week.

You are most welcome, Lynn.

Please rate the answer excellent / good, if you are satisfied. Only a positive rating gives us credit for time and expertize.

Have a great week, you too.
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