<s>[INST] why is it that my boyfriend gets a fever of 103 everyday for last week at the same time with extreme chills after?? he went and got blood work done and everything was normal except his white blood cells were elevated. and the area around his liver was tender but liver tests were normal [/INST] Hi. Thank you for writing to Chat Doctor. Your boyfriend seems to be presenting a pattern of fever that is typical in malarial infections. I would recommend that you have his blood tested for QBC malaria or a peripheral smear (whichever is available). The fever spikes when the parasites enter the blood and subsides when they hide inside an organ. Liver being tender is also suggestive of malaria (Liver function tests may be normal in early stages). Also since his ABCs are elevated it does indicate an infection. It would be useful to know the differentials such as if neutrophils are raised then it suggests a bacterial infection and in that case typhoid must be ruled out. If lymphocytes are elevated then it may be viral and dengue must be ruled out. Therefore, it is my opinion that you have him evaluated for this fever of unknown origin by a physician for a detailed work up, blood tests and ultrasound of the liver or may be CT scan of the abdomen. Based on the results appropriate management may be indicated. Currently, paracetamol to reduce fever is the only symptomatic option. Management for malaria, typhoid and dengue vary considerably. Hope this helps. Do let me know if you have any other questions. </s>