Fever of unknown origin in internal medicine.
Y Kucukardaly, N Kocak
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Kucukardaly Y, Kocak N. Fever of unknown origin in internal medicine. J Postgrad Med 2002;48:155-6
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Kucukardaly Y, Kocak N. Fever of unknown origin in internal medicine. J Postgrad Med [serial online] 2002 [cited 2021 Oct 19 ];48:155-6
Available from: https://www.jpgmonline.com/text.asp?2002/48/2/155/119
We read with interest the article by Kejariwal et al and wish to share our experience on the same subject. We reviewed analysed 82 patients with a fever of unknown origin (FUO), diagnosed according to the definition of Petersdorf and Beeson, between 1980 and 1999 in a training hospital. The mean age of the patients was 39 years (range 17-87 years). Infection was the principal cause (59%), followed by neoplasm (10.9%), collagenoses/vasculitis (7%) and miscellaneous diseases (2.4%). Sixteen (20.7%) of the FUO cases remained undiagnosed. In the infection group, brucellosis (11 cases, 13%) and tuberculosis (10 cases, 12%) were the commonest. Lymphoma was the most common cause of neoplasm. Systemic lupus erythematosus, polyarteritis nodosa and Still’s disease were causes of FUO in 25%, 21% and 17% of collagenoses/vasculitis group. Clinical recovery occurred in 47 (57.3%) patients, clinical condition remained unchanged in 30 (36.5%) patients and death was observed in 5 (6.2%) patients.
Ramos reported that change of spectrum of the FUO with a decrease of infectious causes (as brucellosis or salmonellosis) and increase neoplasia and collagenoses/vasculitis because of improved diagnostic procedures recent years. But like Kejariwal’s report infection was found to be the most common cause of FUO in our country. We thought that the causes of FUO are usually familiar diseases with uncommon presentati-ons rather than rare disorders. Correct diagnosis is possible from the history, physical examination and routine laboratory tests. Conversely failure to utilise findings correctly, delay in ordering appropriate tests and misinterpretation of test results have all contributed to missed diagnoses. Some authors have reported that nuclear medicine can be most useful in patients with fever of unknown origin, where a focus has to be defined, or in patients where a lesion is known by clinical symptoms or by a radiological imaging., But Meller and Becker say that although the methods that use in vitro or in vivo labelled white blood cells have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. So we thought that we need more evidence about this field. We could use nuclear medicine only in certain cases of FUO so this may be the major cause of unchanged aetiologic distribution of our FUO cases. In our opinion, like Peters’, in the future we need agents which are particularly effective in localising chronic inflammation and agents to distinguish infective and non-infective causes of inflammation. The cases of FUO must be followed up with a multidisciplinary approach for correct diagnosis within the shortest time and at low cost.
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