Fever of unknown origin differential diagnosis: Difference between revisions
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Revision as of 15:50, 9 February 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.; FUO; PUO; pyrexia of unknown origin
Overview
- Fever can be the presenting symptom with many diseases, it is therefore important to differentiate fever of unknown origin from all those diseases which present with fever.
- Because of the broad range of differential diagnosis they can be grouped into four categories based on their etiology.
- Infectious
- Malignant
- Inflammatory
- Miscellaneous[1]
Differential diagnosis
Infectious
These patients mostly have a history of hospitalization, surgical procedures, contact with infected person or travel to an endemic place.[2][3]
Examples include:
- Lyme disease
- Histoplasmosis
- Q fever
- Brucellosis
- Toxoplasmosis
- Leptospirosis
- Ehrlichiosis
- Anaplasmosis
- Tuberculosis
- Infectious mononucleosis
- mycobacterium avium infection etc.
Malignant
They are mostly accompanied by loss of weight, decrease in appetite, lymph node enlargement and aquagenic pruritic mostly occurring after hot shower.
Examples include:
- Hodgkin lymphoma
- myeloproliferative disorders
- Colorectal carcinoma
- Hepatocellular carcinoma
- Renal cell carcinoma
- carcinoma of CNS
- Sarcoma etc.
Autoinflammatory/Rheumatologic
Mostly they have multi organ involvement and lymphadenopathy along with joint symptoms may be present.[4][5]
Examples include:
Miscellaneous
Mostly does not belong to any of the above.
Examples include:
| Disease | History | Physical examination | Laboratory or radiological findings |
|---|---|---|---|
| Subacute Bacterial endocartitis | Recent dental procedures, Joint pain, decrease weight, Night sweats, back pain
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Heart murmur, splinter hemorrhages, Janeway lesions, Roth spots, enlarged spleen.
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Elevated WBCs, decreased platelets, Elevated ESR , presence of Cryoglobulins
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| Abscess | GI, genitourinary, Pelvic procedure or infection , fever, chills, decrease weight, night sweats.
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RUQ tenderness ( subphrenic Abscess),hepatomegaly (hepatic abscess), splenomegaly ( splenic abscess), tenderness on DRE ( pelvic abscess).
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Elevated WBCs and ESR, elevated platelets, Positive CT/MRI findings
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| Tuberculosis of CNS | Previous tuberculosis, Altered mental status, Headace
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Morning temperature spikes, relative bradycardia, Abducens palsy.
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CSF: Increased lymphocytes, increased RBCs, decreased glucose, increased lactate, positive AFB stain and Culture.
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| EBV infection | Exposure to saliva ( kissing disease ) , upper respiratory tract infection
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Enlarged lymph nodes, palatal petechiae, enlarged tonsils, enlarged spleen.
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Decreased WBCs, decreased lymphocytes, atypical lymphocytosis, positive PCR, positive IgM EBV VCA titers, enlarged spleen, increased LFTs.
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References
- ↑ Cunha, Burke A.; Lortholary, Olivier; Cunha, Cheston B. (2015). "Fever of Unknown Origin: A Clinical Approach". The American Journal of Medicine. 128 (10): 1138.e1–1138.e15. doi:10.1016/j.amjmed.2015.06.001. ISSN 0002-9343.
- ↑ Cunha, Burke A.; Lortholary, Olivier; Cunha, Cheston B. (2015). "Fever of Unknown Origin: A Clinical Approach". The American Journal of Medicine. 128 (10): 1138.e1–1138.e15. doi:10.1016/j.amjmed.2015.06.001. ISSN 0002-9343.
- ↑ Salzberger B, Schneidewind A, Hanses F, Birkenfeld G, Müller-Schilling M (2012). "[Fever of unknown origin. Infectious causes]". Internist (Berl). 53 (12): 1445–53, quiz 1454-5. doi:10.1007/s00108-012-3173-8. PMID 23111594.
- ↑ Kümmerle-Deschner JB (2017). "[Autoinflammatory Diseases as a Differential Diagnosis of Fever of Unknown Origin]". Dtsch Med Wochenschr. 142 (13): 969–978. doi:10.1055/s-0043-103468. PMID 28672419.
- ↑ 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.