Fever of unknown origin laboratory findings

Resident Survival Guide

Fever of unknown origin Microchapters
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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

A comprehensive and meticulous history (i.e. illness of family members, recent visit to the tropics, medication), repeated physical examination (i.e. skin rash, eschar, lymphadenopathy, heart murmur) and a myriad of laboratory tests (serological, blood culture, immunological) are the cornerstone of finding the cause.

Laboratory Findings

Initial laboratory studies in patients with FUO

• Complete blood count with differential
• Basic metabolic panel
• Liver function test including AST, ALT, LDH, bilirubin, alkaline phosphatase
• Creatine kinase
• Blood cultures (at least 2 sets)
• Urinalysis with microscopic examination
• Urine cultures
• Erythrocyte sedimentation rate
• C-reactive protein
• Gamma-glutamyl transferase
• Coombs test
• Cold agglutinins
• Ferritin
• Angiotensin-converting enzyme

• Thyroid peroxidase and anti-thyroglobulin antibodies
• Antinuclear antibodies
• Rheumatoid factor
• Cryoglobulins
• CMV IgM antibodies and heterophile antibody test if positive for atypical lymphocytes
• Q fever antibodies for patients with exposure to livestocks
• HIV antibody
• Serum protein electrophoresis
• Tuberculin skin test
• Fecal occult blood test