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Hannah Eloise Wilding, Amy Hays
A thirty-eight year-old male presented with a seven-week history of persistent fever accompanied by recurrent night sweats, chills, arthralgias, headache, and chest tightness.Initial laboratory testing showed non-specific elevation of inflammatory markers, but was otherwise unremarkable.A palmar rash developed one week later, prompting testing for syphilis. Fluorescent treponemal antibody absorption (FTA-ABS) and rapid plasma reagin (RPR) tests were both positive.Penicillin G was administered and the patient recovered uneventfully...
March 2024: Clinical Case Reports
#22
JOURNAL ARTICLE
Johanna-Felicia Brauner, Sazan Rasul, Dominik Berzaczy, Daniela Beitzke, Tim Wollenweber, Dietrich Beitzke
BACKGROUND: The diagnosis of large vessel vasculitis (LVV) is often challenging due to the various clinical appearances and the low prevalence. Hybrid imaging by positron emission tomography and computed tomography (PET/CT) is a highly relevant imaging modality for diagnostics and disease surveillance but may be associated with a significant amount of radiation dose especially in patients with complications. OBJECTIVE: The aim of this retrospective analysis was to compare the image quality and impact of hybrid imaging methods PET/CT and PET/MRI on the potential for dose reduction...
March 8, 2024: Wiener Klinische Wochenschrift
#23
JOURNAL ARTICLE
Catia Olianti, Sandra Trapani, Aurelio Secinaro, Michala Holm Reichkendler
Fever of unknown origin (FUO) is a debated issue in numerous scientific studies in adult patients with a not jet-defined workflow in a clinical and diagnostic setting. Few works are published about pediatric patients even if FUO represents a challenging, not infrequent scenario in hospital and outpatient recovery. The fever might be the onset symptom of a transient mild infection or the beginning of a more difficult-to-diagnose and serious pathological condition. In the adult workflow 18 FDG PET-CT is nowadays playing a relevant role, considering the limited spread of conventional 99m Tc-HMPAO-White Blood Cells scintigraphy...
March 8, 2024: Quarterly Journal of Nuclear Medicine and Molecular Imaging
#24
Jagannath S Dhadwad, Ramiz S Kadiwala, Kunal K Modi, Prince R Yadav, Subashini P Vadivel
Hemophagocytic lymphohistiocytosis (HLH) is a rare disease that is even rarer in the adult population. It requires a high degree of suspicion from the treating physician, and if diagnosed early, patients might have a survival benefit from this highly fatal condition. HLH is a disorder of immune regulation where the hyperactivity of cytokines attacks different cells, which leads to multiple organ dysfunctions. Varying presentations and similarities with other diseases make diagnosis difficult. Familial HLH is commonly seen in the pediatric population, while acquired or secondary HLH is seen in adults...
February 2024: Curēus
#25
JOURNAL ARTICLE
William F Wright, Sheetal Kandiah, Rebecca Brady, Barry L Shulkin, Christopher J Palestro, Sanjay K Jain
Fever of unknown origin (FUO) is a clinical conundrum for patients and clinicians alike and imaging studies are often performed as part of the diagnostic workup of these patients. Recently, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) convened and approved a guideline on the use of nuclear medicine tools for FUO. The guidelines support the use of 2-18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in adults and children with FUO. 18F-FDG PET/CT allows the detection and localization of foci of hypermetabolic lesions with high sensitivity, based on 18F-FDG uptake in glycolytically active cells that may represent inflammation, infection, or neoplasia...
March 5, 2024: Clinical Infectious Diseases
#26
JOURNAL ARTICLE
Albrecht Betrains, Lien Moreel, Catharina M Mulders-Manders, Paul G Auwaerter, Joaquim Torné-Cachot, Friedrich Weitzer, Teruhiko Terasawa, Kim H Ly, Verena Schönau, Daniel Blockmans, William F Wright, Chantal Rovers, Steven Vanderschueren
BACKGROUND: Patients with inflammation of unknown origin (IUO) and fever of unknown origin (FUO) are commonly considered a single population. Differences in underlying causes between both groups may steer the diagnostic work-up. METHODS: PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched from July 2009 through December 2023. Studies including both FUO and IUO patients with a sample size of ≥20 were considered. The primary outcome was the difference in the rate of patients affected by predefined diagnostic categories according to meeting FUO or IUO criteria...
March 1, 2024: European Journal of Internal Medicine
#27
Daniele Sola, Carlo Smirne, Francesco Bruggi, Chiara Bottino Sbaratta, Aubin Cardin Tamen Njata, Guido Valente, Maria Cristina Pavanelli, Rosetta Vitetta, Mattia Bellan, Lorenzo De Paoli, Mario Pirisi
Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder. Diagnosis can take a long time, especially in the presence of confounding factors, and it is, to some extent, a process of exclusion. AOSD has life-threating complications ranging from asymptomatic to severe, such as macrophage activation syndrome (MAS), which is also referred to as hemophagocytic lymphohistocytosis (HLH). This condition is correlated with cytokine storm production and monocyte/macrophage overactivation and typically occurs with rash, pyrexia, pancytopenia, hepatosplenomegaly and systemic involvement...
January 29, 2024: Life
#28
JOURNAL ARTICLE
Gwendolyn Fernandes, Pooja Mhashete, Pranav Pramod Patwardhan
Hemophagocytic lymphohistiocytosis (HLH) is a severe and frequently underdiagnosed disorder of systemic immune dysregulation resulting in hypercytokinemia and histologically evident hemophagocytosis, We report a case of a 34-year-old man who presented with breathlessness, generalized weakness, and fever of unknown origin with pancytopenia. Clinically the patient was admitted for febrile illness, and treated symptomatically but his general condition worsened leading to death within 21 hours of admission. A complete autopsy was performed...
July 6, 2023: Indian Journal of Pathology & Microbiology
#29
JOURNAL ARTICLE
Meng-Ting Ma, Wan-Lin Tian, Nan Wu, Qiang Zhang, Feng-Chao Wang
OBJECTIVE: To study the correlation between the number of hemophagocytes and peripheral blood cells in bone marrow of patients with fever of unknown origin. METHODS: A total of 465 patients with fever of unknown origin in our hospital from January 2019 to December 2021 were selected as the research objects, which was to reviewed retrospectively the correlation between the number of hemophagocytes and peripheral blood cells in bone marrow. RESULTS: The positive rates of hemophagocytes detected in the three lines decreased group, the two lines decreased group, the one line decreased group, normal group of the three lines and at least one of the three lines increased group were 86...
February 2024: Zhongguo Shi Yan Xue Ye Xue za Zhi
#30
JOURNAL ARTICLE
Anastasios Stathis, Maria Cristina Pirosa, Lorella Orsucci, Pierre Feugier, Monica Tani, Hervé Ghesquières, Gerardo Musuraca, Francesca Gaia Rossi, Francesco Merli, Romain Guièze, Emmanuel Gyan, Guido Gini, Dario Marino, Remy Gressin, Franck Morschhauser, Federica Cavallo, Francesca Palombi, Annarita Conconi, Benoît Tessoulin, Hervé Tilly, Manuela Zanni, Maria Giuseppina Cabras, Enrico Capochiani, Catello Califano, Melania Celli, Alessandro Pulsoni, Francesco Angrilli, Ubaldo Occhini, René-Olivier Casasnovas, Guillaume Cartron, Liliana Devizzi, Corinne Haioun, Anna Marina Liberati, Roch Houot, Michele Merli, Giuseppe Pietrantuono, Francesca Re, Michele Spina, Francesco Landi, Franco Cavalli, Francesco Bertoni, Davide Rossi, Nicoletta Ielmini, Elena Borgo, Stefano Luminari, Emanuele Zucca, Catherine Thieblemont
The IELSG38 trial was conducted to investigate the effects of subcutaneous (SC) rituximab on the complete remission (CR) rate and the benefits of SC maintenance in patients with extranodal marginal zone lymphoma (MZL) who received frontline treatment with chlorambucil plus rituximab. Study treatment comprised an induction phase with chlorambucil 6 mg/m2/day orally on weeks 1-6, 9-10, 13-14, 17-18, and 21-22, and rituximab 375 mg/m2 intravenously on day 1 of weeks 1-4, and 1400 mg SC on weeks 9, 13, 17, and 21...
February 22, 2024: Haematologica
#31
Yuki Amakusa, Tatsuro Suzuki, Masaya Takemura, Tetsuya Oguri
In cases of Sweet's syndrome with pulmonary involvement, fever of unknown origin, and macrocytic anaemia, VEXAS syndrome can be considered in the differential diagnosis. A 67-year-old man who was taking prednisolone for a fever of unknown origin and Sweet's syndrome was referred to us because of an abnormal chest shadow. Computed tomography revealed a nonfibrotic hypersensitivity pneumonitis-like opacity, and blood test results indicated macrocytic anaemia. His pulmonary symptoms spontaneously improved but again exacerbated approximately 1 month later...
February 2024: Respirology Case Reports
#32
Yan Yu, Bingqian Zhuo, Wei Xu, Lanhui Li, Xinyue Jin, Youqi Ji, Yumei Ge
Complicated case with fever or headache of unknown origin is currently one of the main challenges in clinical diagnosis. A retrospective analysis was conducted on a 27-year-old female patient hospitalized with headache and fever, and the pathogen species were ultimately determined by metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF). The culture results of CSF showed no bacterial or fungal growth. CSF cytology showed a significant increase in nucleated cells. Pathogenic index (corresponded to human gamma herpesvirus 4) of the microorganism after correcting for human background was 12846...
May 2024: Diagnostic Microbiology and Infectious Disease
#33
Ewa Więsik-Szewczyk, Arkadiusz Zegadło, Agnieszka Sobczyńska-Tomaszewska, Marcelina Korzeniowska, Karina Jahnz-Rózyk
Lung involvement is not widely recognized as a complication of auto-inflammatory diseases. We present a broad approach to diagnose a severe form of autoinflammatory syndrome in an adult male patient. A 63-year-old Caucasian male presented with recurrent episodes of high fever, interstitial lung infiltration, and pleural effusion. Laboratory tests performed during the flares revealed lymphopenia and increased levels of C-reactive protein and ferritin. Broad diagnostic research on infections, connective tissue diseases, and malignancies yielded negative results...
2024: Frontiers in Medicine
#34
JOURNAL ARTICLE
Kosuke Oka, Kazuki Tokumasu, Hideharu Hagiya, Fumio Otsuka
Background: Functional hyperthermia (FH) is characterized by hyperthermia resulting from sympathetic hyperactivity rather than inflammation, and it is frequently overlooked by medical practitioners due to the absence of abnormalities in a medical examination. Although FH is an important differential diagnosis for fever of unknown origin (FUO), the literature on FUO cases in Japan lacks information on FH. In this study, we aimed to uncover the population of FH patients hidden in FUO cases. Methods: An outpatient clinic for FUO was established at Okayama University Hospital, and 132 patients were examined during the period from May 2019 to February 2022...
February 3, 2024: Journal of Clinical Medicine
#35
JOURNAL ARTICLE
William F Wright, Albrecht Betrains, Lauren Stelmash, Catharina M Mulders-Manders, Chantal P Rovers, Steven Vanderschueren, Paul G Auwaerter
With a growing emphasis on value-based reimbursement, developing quality indicators for infectious diseases has gained attention. Quality indicators for fever of unknown origin and inflammation of unknown origin are lacking. An assembled group of international experts developed 12 quality measures for these conditions, which could be validated with additional study.
February 2024: Open Forum Infectious Diseases
#36
Aisha M Adam, Omar A Sheikh, Miski A Roble, Mehmet Z Yaşar, Shukri S Mohamed, Mohamed M Kassim
INTRODUCTION AND IMPORTANCE: Fahr's syndrome is primarily familial, autosomal dominant, and genetically diverse. Basal ganglia calcification that is bilaterally symmetrical is a hallmark of this illness. Although the specific origins of this illness are unknown, it may be brought on by problems with calcium metabolism, infections, toxins, hereditary factors, hypoparathyroidism, and pseudohypoparathyroidism. The prevalence of this syndrome is less than 0.5%. CASE PRESENTATION: An 11-year-old female comes to the Emergency Department with her parents complaining of high-grade fever and convulsions for 1 week...
February 2024: Annals of Medicine and Surgery
#37
JOURNAL ARTICLE
Jacob David Miller, Naomy Moskovich, Lior Nesher, Victor Novack
INTRODUCTION: Total body computerized tomography (TBCT) is frequently used as a diagnostic tool for fever of unknown origin (FUO) workup instead of a recommended fluorodeoxyglucose positron emission tomography FDG-PET/CT. We have assessed the TBCT diagnostic yield on a large, unselected cohort of patients with FUO. METHODS: We performed a single-center retrospective cohort study, examining all patients hospitalized in internal medicine between 2012 and 2019 with a documented fever and three negative blood cultures who subsequently had a total-body CT performed...
February 1, 2024: European Journal of Internal Medicine
#38
Charity Iheagwara, Folasade Ajayi, Onyinye N Otaluka, Carlos Cantu Lopez, Jihad Slim, Hamid S Shaaban, Ala Muhanna, Bereket Tewoldemedhin, Maria Szabela, Jack Boghossian
This case report highlights a patient who had persistent fevers for weeks and rapidly progressing pericardial effusion following a positive test for coronavirus disease 2019 (COVID-19) two weeks before presentation to the hospital. The initial thought was that her fever was of infectious etiology, but relevant investigations led to the diagnosis of acute myeloid leukemia (AML). AML, which is characterized by clonal expansion of immature "blast cells" in the peripheral blood and bone marrow resulting in ineffective erythropoiesis and bone marrow failure, is the most prevalent form of leukemia...
January 2024: Curēus
#39
Feng Qin, Xuejiao Hu, Xiaojia Wang, Weijiang Liu, Qianyun Deng, Yunhu Zhao, Caiyun Li, Chao Liu, Zhenchao Huang, Bing Gu
OBJECTIVES: Clinicians often face the challenge of differentially diagnosing febrile patients who are suspected of infectious diseases, since the clinical manifestations of infection and cancer may overlap. A single test that can detect both pathogens and tumor could provide timely and accurate diagnostic clues to aid the treatment and management of these patients. METHODS: We enrolled eight patients to evaluate the utility of metagenomic Next-Generation Sequencing for simultaneously detecting pathogens and neoplasms using body fluids and tissue samples...
January 30, 2024: Heliyon
#40
JOURNAL ARTICLE
Bikash Karki, Niranjan K C, Arun Kumar Mahato, Saksham Kandel, Prakash Acharya
UNLABELLED: Pyrexia of unknown origin refers to a fever of over 38.3°C on multiple occasions for at least three weeks without a known aetiology, even after a week of hospitalization. Adult-onset Still's disease is a rare systemic auto-inflammatory disorder with a prevalence of 0.6/100,000 population characterized by spiking fever, arthralgia or arthritis and maculopapular rash. Here, we present a case of 19 years-old female with pyrexia of unknown origin. With no identifiable cause and fulfilled criteria of Yamaguchi, a diagnosis of adult-onset Still's disease was made...
August 1, 2023: JNMA; Journal of the Nepal Medical Association
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