Understanding Why Would a Fever Keep Coming and Going?

October 1, 2025 •

6 min read

According to the National Institutes of Health, fever is a frequent symptom in children, but recurrent episodes often have a more complex explanation. A fever that keeps coming and going could be a sign of an underlying health issue, ranging from a lingering infection to an autoimmune disease or a genetic condition.

Quick Summary

Recurring fevers, also known as intermittent or relapsing fevers, are not a condition but a symptom indicating an underlying health problem. Potential causes include chronic infections, autoimmune disorders, autoinflammatory syndromes, certain cancers, and drug reactions. Proper diagnosis requires tracking the fever pattern and evaluating associated symptoms.

Key Points

Infections are a Major Cause: Lingering or recurring infections from bacteria, viruses, or parasites (like TB, EBV, or malaria) are common reasons for intermittent fevers.
Autoimmune Conditions Trigger Fever: Diseases such as lupus and rheumatoid arthritis can cause recurring fevers as part of their inflammatory flare-up cycles.
Genetic Syndromes Cause Periodic Fevers: Autoinflammatory diseases like PFAPA and Familial Mediterranean Fever (FMF) are inherited conditions that cause predictable episodes of fever.
Fever Can Indicate Malignancy: Certain cancers, particularly lymphomas, are known to cause a fever pattern that comes and goes, such as Pel-Ebstein fever.
Pattern and Symptoms are Key to Diagnosis: A doctor will analyze the specific pattern of the fever and other symptoms to determine the underlying cause and order appropriate tests.
Seek Medical Help for Persistent Fevers: If a fever lasts longer than a few days, recurs frequently without a clear cause, or is accompanied by severe symptoms, professional medical evaluation is necessary.

What Defines a Fever That Comes and Goes?

Unlike a typical one-off fever from a common cold that resolves in a few days, a fever that keeps coming and going, known as a recurrent or intermittent fever, can be a perplexing symptom. Recurrent fevers are characterized by episodes of elevated body temperature that are separated by periods of normal or near-normal temperature. The pattern and timing of these temperature spikes can provide valuable clues for a healthcare provider. Some conditions, like malaria, can cause a very predictable pattern, such as fever spikes every 48 or 72 hours, known as quotidian, tertian, or quartan fever. Other causes, such as autoinflammatory disorders, might present with regular but unexplained fever cycles. Understanding the nature of the fever—how high it gets, how long it lasts, and the length of the fever-free interval—is crucial for diagnosis.

Common Infectious Causes of Recurring Fevers

One of the most common reasons for a fever that keeps coming and going is an infection that is either chronic, unresolved, or has a specific life cycle. These fevers signal that the body's immune system is persistently fighting an infectious agent. Some notable examples include:

Viral Infections: Viruses like the Epstein-Barr virus (EBV), which causes mononucleosis, can lead to persistent or recurring low-grade fevers and fatigue.
Tick-Borne Relapsing Fever (TBRF): Caused by Borrelia bacteria and transmitted by ticks, this infection is characterized by cycles of high fever lasting several days, followed by fever-free periods, which can repeat multiple times if untreated.
Malaria: This parasitic infection, transmitted by mosquitoes, is infamous for causing intermittent fevers that follow a distinct schedule based on the species of parasite.
Tuberculosis (TB): A serious bacterial infection, primarily affecting the lungs, that can cause persistent, low-grade fevers, especially in the evenings, alongside other symptoms like night sweats and a chronic cough.
Abscesses: A localized collection of pus, such as in the abdomen or lungs, can lead to fluctuating fevers as the body tries to contain the infection.

Non-Infectious and Autoimmune Causes

When infectious causes are ruled out, a recurring fever can point to a systemic inflammatory or autoimmune condition. These diseases involve the immune system mistakenly attacking the body's own tissues, leading to a constant cycle of inflammation and fever.

Systemic Lupus Erythematosus (SLE): Fever is a common manifestation of active lupus, often presenting with an intermittent pattern and other symptoms like joint pain and rash.
Rheumatoid Arthritis: This chronic inflammatory disorder can cause joint pain, swelling, and recurring fevers, especially during flare-ups.
Adult-Onset Still's Disease: A rare type of inflammatory arthritis that is typically characterized by high, daily intermittent fever spikes, a salmon-colored rash, and joint pain.
Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause systemic inflammation that results in fluctuating body temperature.

Periodic and Autoinflammatory Syndromes

Another class of conditions that cause recurring fevers are the hereditary periodic fever syndromes, also known as autoinflammatory diseases. These are genetic disorders that cause unprovoked attacks of inflammation. While rare, they should be considered in cases of unexplained recurring fevers, especially in children.

PFAPA Syndrome: Periodic fever, aphthous stomatitis (mouth sores), pharyngitis (sore throat), and adenitis (swollen lymph nodes) syndrome is the most common periodic fever disorder in children. Episodes typically occur every 3-6 weeks.
Familial Mediterranean Fever (FMF): This genetic disorder causes recurrent, painful inflammation of the abdomen, chest, or joints, accompanied by fever episodes that last 1-3 days.
Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS): Caused by a genetic mutation, this condition can start in childhood or adulthood and is marked by fever, a painful rash, muscle aches, and chills.

Other Potential Triggers

Beyond infectious and immune-related causes, other factors can lead to intermittent fever patterns:

Drug-Induced Fever: Certain medications, such as some antibiotics and anticonvulsants, can cause a fever as a side effect. Discontinuing the drug typically resolves the issue within 48 to 72 hours.
Cancers: Some malignancies, particularly lymphomas (like Hodgkin's lymphoma) and leukemias, can cause fever that comes and goes, sometimes following a specific cycle known as Pel-Ebstein fever.
Post-Trauma or Post-Surgical Fever: The body's inflammatory response to a recent injury or surgery can sometimes cause fever that fluctuates during the recovery process.
Dehydration: In some cases, fluctuating body temperature can be linked to external factors such as dehydration, which can impact the body's ability to regulate its temperature effectively.

Comparing Types of Recurring Fevers


Feature	Intermittent Fever	Relapsing Fever	Periodic Fever Syndrome (e.g., PFAPA)
Temperature Pattern	Fluctuates between normal and elevated within a 24-hour period.	Cycles of fever separated by days or weeks of normal temperature.	Predictable episodes of fever separated by regular, symptom-free intervals.
Duration of Fever	Lasts for several hours at a time, often during the course of an infectious illness.	Episodes can last 2-7 days, with intervals up to a couple of weeks.	Each fever episode typically lasts 3-6 days.
Associated Symptoms	May include chills, body aches, fatigue, and symptoms related to the underlying infection.	Headaches, muscle and joint pain, and potential complications like liver or heart issues.	Mouth sores, sore throat, and swollen lymph nodes, especially in children.
Example Causes	Malaria, sepsis, pneumonia, UTIs.	Tick-borne Borreliosis, Hodgkin's lymphoma (Pel-Ebstein fever).	PFAPA, Familial Mediterranean Fever (FMF), TRAPS.

When to Seek Medical Attention

While some intermittent fevers might be linked to mild, self-resolving infections, a persistent or recurring fever should be evaluated by a healthcare professional, as it may signal a more serious underlying issue. You should seek medical advice in the following circumstances:

High or Prolonged Fever: For adults, if the fever reaches 103°F (39.4°C) or higher, or if it lasts longer than three to five days.
Infants and Children: An infant under three months with any fever requires immediate medical attention. For older children, a fever over 102°F lasting more than a day warrants a doctor's visit, especially if they are irritable or have other symptoms.
Accompanying Severe Symptoms: Seek immediate medical care if the fever is accompanied by a severe headache, stiff neck, rash, chest pain, mental confusion, or difficulty breathing.
Frequency of Recurrence: If you experience repeated fever episodes without a clear cause, even if you feel well between episodes, it's important to consult a physician for proper diagnosis.
Travel History: If the fever appears after travel to certain regions, especially tropical areas, to rule out diseases like malaria.
Known Chronic Conditions: If you have a diagnosed chronic illness, autoimmune disease, or a weakened immune system and experience recurring fevers.

The Diagnostic Process for Recurring Fevers

To diagnose the cause of a fever that comes and goes, a doctor will start with a comprehensive medical history and physical examination. They will likely ask about the pattern of the fever, any associated symptoms, recent travel, and medications. Diagnostic tests are then used to narrow down the possibilities. These may include:

Blood Tests: Complete Blood Count (CBC) to check for signs of infection or inflammatory conditions, and tests for inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Specific tests for autoantibodies (e.g., in lupus) or infectious agents might also be ordered.
Cultures: Blood or urine cultures can identify bacterial infections.
Imaging: A chest X-ray, CT scan, or abdominal ultrasound may be performed to check for abscesses or other sources of infection or inflammation.
Genetic Testing: In some cases, especially in children with suspected periodic fever syndromes, genetic testing may be used to confirm a diagnosis.

Conclusion

While a single fever is a common and often self-limiting symptom, a fever that keeps coming and going requires medical investigation. It is a sign that the body is dealing with an ongoing issue, whether it's an underlying infection, a chronic inflammatory disorder, or a genetic condition. Early and accurate diagnosis is crucial for effective management and can prevent potential complications. By paying close attention to the pattern of your fever and any accompanying symptoms, and seeking timely medical advice, you can get to the root of the problem and receive the right treatment.(https://www.mercymedicalurgentcare.com/post/when-does-a-fever-warrant-a-trip-to-urgent-care)

Frequently Asked Questions

An intermittent fever is one where the body temperature returns to normal within a 24-hour period before rising again, often associated with infectious diseases. A relapsing fever is characterized by repeated episodes of fever that are separated by periods of several days or weeks of normal temperature.

While emotional stress is not a direct cause of fever, it can trigger flare-ups in some autoimmune or autoinflammatory conditions that manifest with fever. It can also influence the frequency of attacks in conditions like Familial Mediterranean Fever.

You should seek medical attention immediately if your infant is under three months old with any fever. For older children, be concerned if a fever lasts more than a day, exceeds 102°F, or is accompanied by unusual irritability, lethargy, or severe symptoms.

Yes, some medications can cause a drug-induced fever, which may present in an intermittent or hectic pattern. Antibiotics are a frequent cause. The fever typically resolves within 48 to 72 hours after stopping the offending drug.

Not all recurring fevers indicate a serious condition, but they should always be evaluated by a medical professional. While they can result from common, self-limited viral infections, they can also be a sign of a more serious underlying issue that requires specific treatment.

Diagnostic tests often include blood work (CBC, inflammatory markers), blood or urine cultures to check for infection, and imaging like X-rays or CT scans. In some cases, specialized tests for autoimmune markers or genetic testing for autoinflammatory syndromes may be necessary.

PFAPA syndrome stands for Periodic Fever, Aphthous stomatitis, Pharyngitis, and Adenitis. It is a common periodic fever syndrome in young children, causing high fevers that recur every few weeks and are accompanied by mouth sores, sore throat, and swollen lymph nodes.