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==Suspected Fever of Unknown Origin==
==SLE Presentation==<ref name="pmid11085805">{{cite journal |vauthors=Tench CM, McCurdie I, White PD, D'Cruz DP |title=The prevalence and associations of fatigue in systemic lupus erythematosus |journal=Rheumatology (Oxford) |volume=39 |issue=11 |pages=1249–54 |year=2000 |pmid=11085805 |doi= |url=}}</ref><ref name="pmid7779127">{{cite journal |vauthors=McKinley PS, Ouellette SC, Winkel GH |title=The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. A proposed model |journal=Arthritis Rheum. |volume=38 |issue=6 |pages=826–34 |year=1995 |pmid=7779127 |doi= |url=}}</ref><ref name="pmid9598886">{{cite journal |vauthors=Wang B, Gladman DD, Urowitz MB |title=Fatigue in lupus is not correlated with disease activity |journal=J. Rheumatol. |volume=25 |issue=5 |pages=892–5 |year=1998 |pmid=9598886 |doi= |url=}}</ref>
* Fever higher than 38.3°C (100.9°F) on several occasions
*[[Fatigue]]
* Persisting without diagnosis for at least 3 weeks
*[[Fever]]
* At least 1 week's investigation in hospital
*[[Myalgia]]
*Joint [[tenderness]]
*[[Muscle weakness]]
*[[Weight]] changes
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Revision as of 17:33, 30 March 2018

==SLE Presentation==[1][2][3]

 
 
 
 
 
 
 
 

Focused History

  • Verify the presence of fever and its pattern[4][5]
  • History of previous surgeries or procedures
  • History of malignancy and related therapy
  • History of previously treated infections
  • History of sick or animal contacts
  • History of psychiatric illness
  • History of recent traveling
  • History of comorbidities
  • History of medications
  • History of transfusions
  • Social and family history
 
 
 
 
 
 
 
 

Physical Examination

Vitals

Skin

Head

Eyes

Mouth

Neck

Lungs

Heart

Abdomen

Genitourinary

Extremities

Neurologic

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Imaging Study

Chest Radiograph

  • Chest radiograph should be considered as a part of the initial diagnostic workup.

Echocardiography

  • Echocardiography should be considered when suspecting endocarditis.

Abdominal Ultrasonography

  • Abdominal ultrasonography should be considered when suspecting hepatobiliary pathology.

Chest CT Scan

Abdominal CT Scan

Positron Emission Tomography

  • PET may be useful in localizing the nidus of fever of unknown origin.
 
 
 
 
 
 
 
 

Other Investigation

Lymph Node Biopsy

Bone Marrow Biopsy

  • Bone marrow biopsy may be considered when suspecting intracellular infectious pathogens or hematologic malignancies.

Discontinuation of Nonessential Medications

  • Nonessential medications should be discontinued.
  • Defervescence in less than 72 hours after discontinuing the culprit medication suggests drug fever.
  • Rechallenge with the offending agent usually results in recurrence of drug fever.

Trial of Empiric Antibiotics

  • Therapeutic trials of antimicrobial agents may be considered if other techniques fail to disclose the etiology.
  • An infectious etiology is likely if abatement of fever occurs after the administration of empiric antibiotics.

Naproxen Test

  • Naproxen test (375 mg twice daily) can be used to distinguish neoplastic fever from other etiologies.
  • Naproxen test is considered positive when there is a rapid or sustained abatement of fever during the 3 days of the trial period.
  • Defervescence within 12 hours occurs in almost all patients with neoplastic fever.
  • Fever recurs after discontinuation of naproxen in patients with neoplasms.
  • Naproxen demonstrated no antipyretic activity against fever in patients with occult infection.
 
 
  1. Tench CM, McCurdie I, White PD, D'Cruz DP (2000). "The prevalence and associations of fatigue in systemic lupus erythematosus". Rheumatology (Oxford). 39 (11): 1249–54. PMID 11085805.
  2. McKinley PS, Ouellette SC, Winkel GH (1995). "The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. A proposed model". Arthritis Rheum. 38 (6): 826–34. PMID 7779127.
  3. Wang B, Gladman DD, Urowitz MB (1998). "Fatigue in lupus is not correlated with disease activity". J. Rheumatol. 25 (5): 892–5. PMID 9598886.
  4. Isaac, Benedict (1991). Unexplained fever : a guide to the diagnosis and management of febrile states in medicine, surgery, pediatrics, and subspecialties. Boca Raton: CRC Press. ISBN 9780849345562.
  5. Cunha, B. A. (1996-03). "The clinical significance of fever patterns". Infectious Disease Clinics of North America. 10 (1): 33–44. ISSN 0891-5520. PMID 8698993. Check date values in: |date= (help)