Understanding What Is a Fever That Comes and Goes?

October 1, 2025 •

5 min read

According to the National Institutes of Health, a fever is an elevated body temperature of 100.4°F or higher. When a high temperature presents in a fluctuating pattern, it raises questions and points toward a specific group of conditions. Understanding what is a fever that comes and goes can help identify the root cause, which can range from a common infection to a more complex chronic illness.

Quick Summary

A fever that comes and goes, also known as an intermittent or recurrent fever, is characterized by episodes of elevated body temperature that alternate with periods of normal temperature. Common triggers include infections, autoimmune conditions, and autoinflammatory diseases. Diagnostic methods involve blood tests and medical imaging to identify the root cause, leading to targeted treatment.

Key Points

Pattern Recognition: Intermittent fever is characterized by temperature spikes that return to normal, unlike continuous fevers that stay elevated.
Diverse Causes: Fluctuating fevers can be caused by infections (e.g., malaria, TB), autoimmune disorders (e.g., lupus), autoinflammatory syndromes (e.g., PFAPA), certain cancers, and drug reactions.
Comprehensive Diagnosis: Identifying the cause requires a detailed medical history, physical exam, and specific tests, including blood work, imaging, or genetic screening.
Targeted Treatment: Management depends on the root cause and can involve antibiotics for bacterial infections, anti-inflammatory drugs for autoimmune conditions, or supportive care for viral illnesses.
Warning Signs: Immediate medical attention is needed if a recurring fever is accompanied by severe symptoms like confusion, stiff neck, or difficulty breathing.
Pediatric Considerations: In children, conditions like PFAPA syndrome can cause regular, recurring fever episodes, often with other specific symptoms like mouth sores and sore throat.

Causes of a Fever That Comes and Goes

A fluctuating fever is not an illness itself but a symptom indicating that the body is fighting an underlying issue. The pattern, duration, and accompanying symptoms can offer crucial clues to a diagnosis. The causes can be broadly categorized into infectious, inflammatory, and other systemic conditions.

Infectious Causes

Many infectious agents can lead to intermittent fever patterns, where the fever spikes and then subsides.

Viral Infections: Some viruses, like the Epstein-Barr virus (EBV), cause cyclic fevers that can persist for weeks or months. Other common viruses like influenza or COVID-19 can also trigger intermittent fevers.
Bacterial Infections: Certain bacterial infections are known for their distinct fever patterns. Examples include:
- Malaria: Caused by a parasite, this disease results in fever spikes that can occur every 24, 48, or 72 hours, depending on the specific parasite species.
- Tuberculosis (TB): A chronic bacterial infection that often presents with a persistent or low-grade fever that can be intermittent.
- Relapsing Fever: Caused by Borrelia bacteria transmitted by ticks or lice, this condition is characterized by episodes of high fever separated by periods of feeling well.
- Localized Infections: An abscess, which is a localized pocket of pus, can also cause fluctuating fevers until the infection is drained and treated.

Inflammatory and Autoimmune Disorders

When the immune system malfunctions, it can cause chronic inflammation that manifests as recurring fevers.

Autoimmune Diseases: Conditions like Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) can cause intermittent fevers, particularly during flare-ups. The body's immune system mistakenly attacks its own tissues, leading to systemic inflammation.
Adult-Onset Still's Disease (AOSD): A rare form of inflammatory arthritis that features daily high fever spikes, often occurring in the evening.
Periodic Fever Syndromes (Autoinflammatory Diseases): These are a group of genetic conditions where the innate immune system triggers recurrent fever episodes. PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) is the most common and primarily affects young children, causing fever episodes every few weeks.

Other Potential Causes

Medication-Induced Fever: Certain drugs, including some antibiotics and anticonvulsants, can cause a fever that comes and goes as a side effect.
Cancers: Certain cancers, especially lymphomas and leukemias, can cause unexplained intermittent fever as an early symptom.
Environmental Factors: Dehydration and heat exhaustion can cause fluctuating body temperature as the body struggles to regulate itself.

Recognizing Associated Symptoms

Intermittent fevers are often accompanied by other signs that can help pinpoint the underlying cause. Keeping a log of symptoms alongside fever spikes can provide valuable information to a doctor.

General symptoms accompanying fever spikes:
- Chills and shivering signaling the onset of fever
- Sweating as the fever subsides
- Headaches and muscle aches
- Fatigue and malaise
- Loss of appetite
Condition-specific symptoms:
- PFAPA Syndrome: Mouth sores (aphthous stomatitis), sore throat (pharyngitis), and swollen lymph nodes (adenitis).
- Lupus or RA: Joint pain, stiffness, and potential skin rashes.
- Relapsing Fever: Severe headache, muscle pain, and potentially a skin rash.

Diagnostic Approach

Diagnosing the cause of a recurring fever is often a process of elimination. A doctor will start with a comprehensive evaluation.

Detailed Medical History: The doctor will ask about the fever pattern (frequency, duration), other symptoms, recent travel, exposure to infections, current medications, and any family history of autoimmune diseases.
Physical Examination: A thorough exam can reveal clues like swollen lymph nodes, rashes, or joint inflammation.
Laboratory Tests: Blood tests are a key part of the diagnostic process. Tests may include:
- Complete Blood Count (CBC): Checks for signs of infection.
- Inflammatory Markers (CRP, ESR): Elevated levels can point to inflammation.
- Blood Cultures: To check for bacterial infections in the bloodstream.
Imaging: Chest X-rays or abdominal CT scans may be used to locate infections or inflammatory sites.
Specialized Tests: Depending on the suspected cause, genetic tests for hereditary fever syndromes or serologic tests for specific infections like malaria may be performed.

Comparison of Fever Patterns


Feature	Intermittent Fever	Remittent Fever	Relapsing Fever
Temperature Pattern	Fluctuates between elevated and normal levels within a 24-hour period.	Fluctuates significantly but never returns to a normal baseline within a 24-hour period.	Episodes of fever lasting several days, separated by fever-free periods of several days or weeks.
Associated Conditions	Malaria, sepsis, abscesses, Still's disease, PFAPA.	Bacterial infections like endocarditis, typhoid fever, brucellosis.	Caused by Borrelia bacteria from ticks or lice.
Pathophysiology	Fever spikes often correspond to the timing of the causative agent's life cycle or the body's inflammatory response.	Reflects ongoing inflammation where the body's thermoregulatory set point remains elevated.	Caused by antigenic variation of the spirochetes, prompting repeated immune responses.

Treatment and Management

Treating a fever that comes and goes involves addressing the underlying condition, not just the temperature itself. The approach varies significantly depending on the diagnosis.

For Infections: If a bacterial infection is identified, a course of antibiotics is necessary. Specific antimalarial drugs are used for malaria, while prompt antibiotic therapy is crucial for relapsing fever. Viral fevers often require supportive care, including rest and fluids.
For Autoimmune and Autoinflammatory Diseases: Management typically involves anti-inflammatory or immunosuppressive drugs to control the immune system's response. Corticosteroids can shorten PFAPA episodes, while lifelong colchicine is a primary treatment for FMF. Biologic medications may also be used in severe cases.
Supportive Home Care: For all causes, managing symptoms at home can improve comfort. This includes:
- Staying well-hydrated with water, broth, or oral rehydration solutions.
- Getting plenty of rest.
- Wearing light clothing and keeping the room cool.
- Using over-the-counter fever reducers like acetaminophen or ibuprofen, following dosage instructions carefully, though these may not be effective for all conditions, such as PFAPA.

When to Seek Medical Attention

While many intermittent fevers resolve on their own, some situations require prompt medical evaluation. It's especially important to be cautious with infants, the elderly, or those with weakened immune systems.

Seek immediate medical attention if a fever is accompanied by:

Severe headache or a stiff neck
Confusion, delirium, or loss of consciousness
Difficulty breathing or chest pain
Persistent vomiting
Skin rash or unusual bruising
Seizures
A very high temperature (103°F or higher for adults) that does not respond to medication

Consult a doctor if:

The fever lasts for more than 48–72 hours.
The fever returns after a period of normal temperature.
Your child is under 3 months old and has a fever of 100.4°F or higher.
The fever is accompanied by night sweats or unexplained weight loss.

Conclusion

A fever that comes and goes, also known as intermittent fever, is a symptom with a wide range of potential causes, from common viral infections to more serious chronic conditions like autoimmune diseases or specific genetic syndromes. While some cases may resolve with simple rest and hydration, a thorough medical evaluation is often necessary to pinpoint the precise cause and ensure appropriate treatment. Monitoring the fever pattern and associated symptoms is key to guiding the diagnostic process. Recognizing when to seek professional medical advice, particularly in the presence of severe accompanying symptoms, is crucial for effective management and a positive health outcome. A detailed clinical history, combined with targeted laboratory and imaging tests, provides the pathway to a correct diagnosis and the most effective course of action. For many, consulting with a healthcare provider is the best step toward finding clarity and relief.

For more information on different types of fevers, visit the Merck Manual Consumer Version.

Frequently Asked Questions

An intermittent fever fluctuates between elevated and normal temperature within a 24-hour period. A relapsing fever features episodes of fever lasting several days, separated by periods of feeling normal that last a week or more.

Yes, autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) can cause recurring fevers. The fever is part of the body's immune response to the chronic inflammation caused by the condition.

PFAPA stands for periodic fever, aphthous stomatitis, pharyngitis, and adenitis. It is the most common autoinflammatory periodic fever syndrome in children, causing recurrent fevers with mouth sores, sore throat, and swollen lymph nodes.

Diagnosis involves a doctor evaluating the patient's medical history and symptoms, followed by tests such as blood work (e.g., CBC, CRP), imaging (e.g., X-rays), and possibly genetic testing to rule out different conditions.

Treatment focuses on addressing the underlying cause. For infections, this may mean antibiotics or antivirals. For inflammatory conditions, it may involve anti-inflammatory medications. Supportive care, including rest and hydration, is also important.

You should see a doctor if the fever lasts more than 48–72 hours, returns after a period of being normal, or is accompanied by severe symptoms like a stiff neck, confusion, or difficulty breathing. Any fever in a newborn requires immediate medical evaluation.

No, they are not always serious and can be caused by simple infections. However, a fluctuating or recurring fever warrants medical investigation to rule out more serious underlying conditions, especially if accompanied by other concerning symptoms.