Fever of unknown origin differential diagnosis

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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

1. 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.
2. Because of the broad range of differential diagnosis they can be grouped into four categories based on their etiology.

• Infectious
• Malignant
• Inflammatory
• Miscellaneous

Differential diagnosis

Infectious

These patients mostly have a history of hospitalization, surgical procedures, contact with infected person or travel to an endemic place.

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
• Hepatoma
• Renal cell carcinoma
• carcinoma of CNS
• Sarcoma etc.

Auto Inflammatory

Mostly they have multi organ involvement and lymphadenopathy along with joint symptoms may be present.

Examples include:

• Systemic lupus erythematosus
• Polymyositis
• Dermatomyositis
• Polymyalgia rheumatica etc.

Miscellaneous

Mostly does not belong to any of the above.

Examples include:

• Familial Mediterranean fever.
• Drug fever
• Thyroiditis
• Hypertriglyceridemia etc.