Relative bradycardia is often present.ĥ) Other: Alcoholic hepatitis, thyroiditis, pulmonary embolism (generally recurrent and undetected, without severe clinical symptoms), hematomas, factitious fever.Ģ. Fever may be accompanied by erythematous, macular, or maculopapular rash and increased eosinophil counts. ![]() It usually develops within 1 to 2 weeks of starting treatment (although it may occur at any point of treatment) and resolves spontaneously within 48 to 72 hours (later in patients with liver disease or renal failure). ![]() Drug-induced fever is more frequent in the elderly. ![]() In elderly patients more frequent causes are temporal arteritis, polymyalgia rheumatica, and rheumatoid arthritis.ģ) Cancer: Most frequently hematologic and lymphatic malignancies (Hodgkin lymphoma, non-Hodgkin lymphoma, leukemia, myelodysplastic syndrome), clear cell renal cell carcinoma, hepatic adenoma, liver cancer, pancreatic cancer, colorectal cancer, primary central nervous system ( CNS) malignancies.Ĥ) Drugs (usually polytherapy): Most frequently penicillins, sulfonamides, vancomycin, amphotericin B, salicylates, bleomycin, interferons, quinidine derivatives, phenothiazine derivatives (promethazine, thiethylperazine), barbiturates, phenytoin, methyldopa, haloperidol ( neuroleptic malignant syndrome), tricyclic antidepressants, and lithium. The most important causes of classic FUO:ġ) Infection (the longer the duration of FUO, the more unlikely the infectious etiology): Most frequently pulmonary and extrapulmonary tuberculosis ( TB), abscess (intraabdominal, subphrenic, perinephric, pelvic), infectious endocarditis, cytomegalovirus ( CMV) infection, toxoplasmosis, typhoid fever, paratyphoid fever, chronic prostatitis less frequently systemic fungal infection or zoonotic diseases (mostly travel-associated infections, particularly those linked to travelling to tropical countries), such as malaria, leptospirosis, brucellosis, tularemia, psittacosis, rickettsial infections (spotted fevers, typhus), Q fever, anaplasmosis, ehrlichiosis, bartonellosis, and cat-scratch disease.Ģ) Inflammatory diseases: Systemic connective tissue diseases (most frequently adult-onset Still disease, polyarteritis nodosa, systemic lupus erythematosus) and inflammatory bowel disease (particularly Crohn disease). In hospitalized patients (after ≥2 days of hospitalization) as well as patients with neutropenia or HIV infection, FUO is diagnosed if the following criteria are met:Ģ) The cause has not been established or diagnosis remains uncertain despite routine inpatient diagnostic investigations continued for 3 to 5 days.ġ. ![]() Its key feature is fever that does not resolve spontaneously, persists longer than an average infectious disease, and whose cause remains unknown despite routine investigations.Ĭlassic FUO is diagnosed if all of the 3 following criteria are met:ġ) Fever >38.3 degrees Celsius that persists or recurs on several occasions.ģ) The cause has not been established or remains uncertain despite routine diagnostic investigations continued for ~1 week (≥3 days in the hospital or ≥3 outpatient visits). Authors: Piotr Zaborowski, Jacek Mrukowiczįever of unknown origin ( FUO) is a clinical entity that may have various causes.
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