Fever of unknown origin other diagnostic studies: Difference between revisions
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| style="vertical-align: middle; padding: 5px;" align=center | [[Fever of unknown origin resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | | style="vertical-align: middle; padding: 5px;" align="center" |[[Fever of unknown origin resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | ||
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==Overview== | ==Overview== | ||
Other than laboratory work up some other investigation listed below may be helpful in finding cause of FUO.<ref name="pmid27964789">{{cite journal| author=Mulders-Manders CM, Simon A, Bleeker-Rovers CP| title=Rheumatologic diseases as the cause of fever of unknown origin. | journal=Best Pract Res Clin Rheumatol | year= 2016 | volume= 30 | issue= 5 | pages= 789-801 | pmid=27964789 | doi=10.1016/j.berh.2016.10.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27964789 }}</ref> | |||
==Imaging Studies== | ==Imaging Studies== | ||
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===Positron Emission Tomography=== | ===Positron Emission Tomography=== | ||
[[Positron emission tomography | [[Positron emission tomography|PET scan]] can be used it is helpful in less than 50 % of cases. | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
===Lymph Node Biopsy=== | ===Lymph Node Biopsy=== | ||
Lymph node biopsy may be useful when suspecting [[lymphoma]], [[lymphogranuloma venereum]], [[toxoplasmosis]], and [[Kikuchi disease]]. Granulomas in lymph node biopsies may indicate a disorder associated with granulomatous [[inflammation]] (eg, [[tuberculosis]], [[sarcoidosis]]) or [[lymphoma]]. The preferred lymph nodes to biopsy are the posterior cervical, epitrochlear, or supraclavicular nodes. | Lymph node biopsy may be useful when suspecting [[lymphoma]], [[lymphogranuloma venereum]], [[toxoplasmosis]], and [[Kikuchi disease]]. Granulomas in lymph node biopsies may indicate a disorder associated with granulomatous [[inflammation]] (eg, [[tuberculosis]], [[sarcoidosis]]) or [[lymphoma]]. The preferred lymph nodes to biopsy are the posterior cervical, epitrochlear, or supraclavicular nodes. | ||
===Bone Marrow Biopsy=== | ===Bone Marrow Biopsy=== | ||
Bone marrow biopsy may be considered when | Bone marrow biopsy may be considered when there are clues for hematologic malignancies. | ||
===Naproxen Test=== | ===Naproxen Test=== | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Ailments of unknown etiology]] | [[Category:Ailments of unknown etiology]] | ||
Revision as of 13:24, 25 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: febris continua e causa ignota; febris e causa ignota; febris E.C.I.; fever/pyrexia of obscured/undetermined/uncertain/unidentifiable/unknown focus/origin/source; fever/pyrexia without a focus/origin/source; FUO; PUO
Overview
Other than laboratory work up some other investigation listed below may be helpful in finding cause of FUO.[1]
Imaging Studies
Chest Radiograph
Chest radiograph should be considered as a part of the initial diagnostic workup.
Echocardiography
Echocardiography should be performed when suspecting endocarditis.
Abdominal Ultrasonography
Hepatobiliary pathology may be detected by abdominal ultrasonography.
Chest CT Scan
CT scan of the chest may detect nodular lesions (suggestive of malignancy, fungal, mycobacterial, or nocardial infection) and mediastinal adenopathy (suggestive of lymphoma, histoplasmosis, or sarcoidosis).
Abdominal CT Scan
An abdominal CT scan may show intra-abdominal abscess or malignancy of the visceral organs.
Positron Emission Tomography
PET scan can be used it is helpful in less than 50 % of cases.
Other Diagnostic Studies
Lymph Node Biopsy
Lymph node biopsy may be useful when suspecting lymphoma, lymphogranuloma venereum, toxoplasmosis, and Kikuchi disease. Granulomas in lymph node biopsies may indicate a disorder associated with granulomatous inflammation (eg, tuberculosis, sarcoidosis) or lymphoma. The preferred lymph nodes to biopsy are the posterior cervical, epitrochlear, or supraclavicular nodes.
Bone Marrow Biopsy
Bone marrow biopsy may be considered when there are clues for hematologic malignancies.
Naproxen Test
Naproxen test can be used to distinguish neoplastic fever from other etiologies of FUO.
At a dosage of 375 mg twice daily, naproxen demonstrated no antipyretic activity against fever in patients with occult infection. Defervescence within 12 hours occurs in almost all patients with neoplastic fever. The naproxen test is considered positive when there is a rapid or sustained abatement of fever during the 3 days of the trial period. Fever recurs after discontinuation of naproxen in patients with neoplasms.[2]
References
- ↑ Mulders-Manders CM, Simon A, Bleeker-Rovers CP (2016). "Rheumatologic diseases as the cause of fever of unknown origin". Best Pract Res Clin Rheumatol. 30 (5): 789–801. doi:10.1016/j.berh.2016.10.005. PMID 27964789.
- ↑ Chang, J. C. (1987-03). "How to differentiate neoplastic fever from infectious fever in patients with cancer: usefulness of the naproxen test". Heart & Lung: The Journal of Critical Care. 16 (2): 122–127. ISSN 0147-9563. PMID 3028981. Check date values in:
|date=(help)