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

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.

These patients mostly have a history of hospitalization, surgical procedures, contact with infected person or travel to an endemic place.^[2]^[3]

Examples include:

They are mostly accompanied by loss of weight, decrease in appetite, lymph node enlargement and aquagenic pruritic mostly occurring after hot shower.

Examples include:

Mostly they have multi organ involvement and lymphadenopathy along with joint symptoms may be present.^[4]^[5]

Examples include:

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	Heart murmur, splinter hemorrhages, Janeway lesions, Roth spots, enlarged spleen.	Elevated WBCs, decreased platelets, Elevated ESR , presence of Cryoglobulins
Abscess	GI, genitourinary, Pelvic procedure or infection , fever, chills, decrease weight, night sweats.	RUQ tenderness ( subphrenic Abscess),hepatomegaly (hepatic abscess), splenomegaly ( splenic abscess), tenderness on DRE ( pelvic abscess).	Elevated WBCs and ESR, elevated platelets, Positive CT/MRI findings
Tuberculosis of CNS	Previous tuberculosis, Altered mental status, Headace	Morning temperature spikes, relative bradycardia, Abducens palsy.	CSF: Increased lymphocytes, increased RBCs, decreased glucose, increased lactate, positive AFB stain and Culture.
EBV infection	Exposure to saliva ( kissing disease ) , upper respiratory tract infection	Enlarged lymph nodes, palatal petechiae, enlarged tonsils, enlarged spleen.	Decreased WBCs, decreased lymphocytes, atypical lymphocytosis, positive PCR, positive IgM EBV VCA titers, enlarged spleen, increased LFTs.

↑ 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.