Prolonged Febrile Illness and Fever of Unknown Origin in Adults
ELIZABETH C. HERSCH, COL, MC, USA, General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri ROBERT C. OH, LTC, MC, USA, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
Am Fam Physician. 2014 Jul 15;90(2):91-96.
Fever of unknown origin is diagnosed as a temperature above 101°F for three more weeks without and establish course, although the definition has changed throughout history. The differential diagnosis is broad but the most common categories are infection ,malignancy or an inflammatory disease. Some medications that can cause FUO include barbiturates, antihistamines, antimicrobials, cardiovascular drugs, and NSAIDs. If a cause cannot be found after a comprehensive history and physical exam, then the minimum diagnostic workup should include CBC, chest x-ray, urinalysis, urine culture, ESR, CRP, electrolytes, LDH, creatinine, blood cultures, rheumatoid factor, serology, ultrasound and CT. Additional workup includes ferritin, cryoglobulins, ANCA, thyroid labs, complement studies, blood smear, serum plasmapheresis, PET CT and possible tissue biopsy.
An elevated ESR May reveal an abdominal or pelvic infection, osteomyelitis or endocarditis. Procalcitonin maybe elevated in bacterial infection. Elevated LDH may be due to malaria, lymphoma, or leukemia. Ferritin may be elevated in lupus, stills disease or temporal arteritis. Cryoglobulins may be elevated in endocarditis, lupus, leukemia and lymphoma. A venous Doppler ultrasound may be helpful if the suggested cause of the fever is thromboembolism. If the origin still cannot be found, an 18F fluorodeoxyglucose positron emission tomography plus CT may help locate an area for biopsy. Areas that are commonly biopsied are lymph nodes, liver, bone marrow and temporal artery. Therapy has not been shown to be helpful. Consultation with the specialist is preferred whenever necessary.
An elevated ESR May reveal an abdominal or pelvic infection, osteomyelitis or endocarditis. Procalcitonin maybe elevated in bacterial infection. Elevated LDH may be due to malaria, lymphoma, or leukemia. Ferritin may be elevated in lupus, stills disease or temporal arteritis. Cryoglobulins may be elevated in endocarditis, lupus, leukemia and lymphoma. A venous Doppler ultrasound may be helpful if the suggested cause of the fever is thromboembolism. If the origin still cannot be found, an 18F fluorodeoxyglucose positron emission tomography plus CT may help locate an area for biopsy. Areas that are commonly biopsied are lymph nodes, liver, bone marrow and temporal artery. Therapy has not been shown to be helpful. Consultation with the specialist is preferred whenever necessary.
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