Thursday, July 31, 2008

Day #31 - Fever of Unknown Origin

Today we discussed a case of true fever of unknown origin.

Epidemiologic Criteria:
  • Fever x 3 weeks (38.3)
  • Failure to find cause despite appropriate initial outpatient/inpatient investigations
Causes:
  • Majority unknown
  • Then infection (most commonly TB or occult abscesses), inflammatory, malignancy, other

Diagnostic tests (beyond initial):
  • CT abdomen to look for abscess, lymphadenopathy, other pathology. Yield ~20%
  • Bone scan (insensitive, but specific with good + LR)
  • Liver biopsy -- regardless of hepatomegaly or LFT abnormalities has yield ~15%
  • Temporal artery biopsy in the elderly -- yield ~ 15%
  • Leg dopplers -- yield 2-6%
  • Bone marrow biopsy-- in those with cytopenias or compatable syndromes. Yield ~1%

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