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Zdeněk Adam, Anna Šedivá, Renata Koukalová, Zdeněk Řehák, Hana Petrášová, Petr Szturz, Zdenka Adamová, Eva Vetešníková, Luděk Pour, Marta Krejčí, Viera Sandecká, Eva Pourová, Zdeňka Čermáková, Sabina Ševčíková, Zdeněk Král, Jiří Mayer
Schnitzlers syndrome is an acquired auto-inflammatory disease of still unclear origin. The Strasbourg criteria were adopted (non-infectious fever, chronic urticaria, changes in the bone structure, leukocytosis and higher values of inflammatory markers - CRP and presence of monoclonal immunoglobulin mostly of type IgM, very rarely of IgG) to establish this diagnosis. The first-choice therapy for this disease is the blocking of interleukin-1 effects. In practice, the interleukin-1 receptor antagonist, anakinra, is the most commonly used...
2016: Vnitr̆ní Lékar̆ství
Manuel Unger, Georgios Karanikas, Andreas Kerschbaumer, Stefan Winkler, Daniel Aletaha
Fever of unknown origin (FUO) was originally characterised in 1961 by Petersdorf and Beeson as a disease condition of temperature exceeding 38.3 °C on at least three occasions over a period of at least three weeks, with no diagnosis made despite one week of inpatient investigation. However, since underlying diseases are often reported for classical FUO, these presentations may not be considered to be of "unknown origin". Rather, the aetiology of prolonged fever may resolve, or not resolve. The definition of fever with unresolved cause (true FUO) is difficult, as it is a moving target, given the constant advancement of imaging and biomarker analysis...
September 26, 2016: Wiener Klinische Wochenschrift
Kalawat Tek Chand, Krishna Kishore Chennu, Lakshmi Amancharla Yadagiri, Ranadheer Manthri Gupta, Ram Rapur, Siva Kumar Vishnubotla
Introduction Studies on fever of unknown origin (FUO) in patients of chronic kidney disease and end stage renal disease patients on dialysis were not many. In this study, we used 18 F-FDG PET/CT scan whole body survey for detection of hidden infection, in patients on dialysis, labelled as FUO. Methods In this retrospective study, 20 patients of end stage renal disease on dialysis were investigated for the cause of FUO using 18F-FDG PET/CT scan. All these patients satisfied the definition of FUO as defined by Petersdorf and Beeson...
September 12, 2016: Hemodialysis International
E Rossi, A Perrone, D Narese, M Cangelosi, S Sollai, A Semeraro, M Mortilla, C Defilippi
Cat-scratch disease (CSD) is a zoonosis in children, result of infection by Bartonella henselae, a gram-negative bacillus. Infection is generally characterized by regional and self-limited lymphadenopathy after exposure to a scratch or bite from a cat. Rarely, B. henselae is cause of fever of unknown origin (FUO), with dissemination to various organs, most often involving the reticuloendothelial system (liver, spleen, bone marrow), mimicking an inflammatory rather than a lymphoproliferative disease. Whole-body Magnetic Resonance Imaging (WBMRI), in association with diffusion-weighted imaging (DWIBS), allows a comprehensive evaluation of pediatric patients, without the risks inherent to ionizing radiation...
July 2016: La Clinica Terapeutica
Marco Ciacciarelli, Davide Bellini, Andrea Laghi, Alessandro Polidoro, Antonio Pacelli, Anna Giulia Bottaccioli, Giuseppina Palmaccio, Federica Stefanelli, Piera Clemenzi, Luisa Carini, Luigi Iuliano, Cesare Alessandri
Fever of unknown origin (FUO) can be an unusual first clinical manifestation of pheochromocytoma. Pheochromocytomas are tumors that may produce a variety of substances in addition to catecholamines. To date, several cases of IL-6-producing pheochromocytomas have been reported. This report describes a 45-year-old woman with pheochromocytoma who was admitted with FUO, normal blood pressure levels, microcytic and hypochromic anemia, thrombocytosis, hyperfibrinogenemia, hypoalbuminemia, and normal levels of urine and plasma metanephrines...
2016: Case Reports in Medicine
Catherine E Foster, Erin G Nicholson, Angela C Chun, Maya Gharfeh, Sara Anvari, Filiz O Seeborg, Michael A Lopez, Judith R Campbell, Lucila Marquez, Jeffrey R Starke, Debra L Palazzi
Fever of unknown origin (FUO) in children is frequently caused by infectious diseases. Angiostrongylus cantonensis, while a primary cause of eosinophilic meningitis, is rarely a cause of FUO. We present two pediatric cases of FUO caused by Angiostrongylus cantonensis acquired in Houston, Texas, outside of its usual geographic distribution.
August 30, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Lusine Paronyan, Eduard Zardaryan, Vahe Bakunts, Zaruhi Gevorgyan, Vigen Asoyan, Hripsime Apresyan, Alvard Hovhannisyan, Karo Palayan, Christian T Bautista, Tinatin Kuchuloria, Robert G Rivard
BACKGROUND: Scant information is available on the infectious causes of febrile illnesses in Armenia. The goal of this study was to describe the most common causes, with a focus on zoonotic and arboviral infections and related epidemiological and clinical patterns for hospitalized patients with febrile illnesses of infectious origin admitted to Nork Infectious Diseases Clinical Hospital, the referral center for infectious diseases in the capital city, Yerevan. METHOD: A chart review study was conducted in 2014...
2016: BMC Infectious Diseases
Panagiota Voukelatou, Elissavet Sfendouraki, Theodoros Karianos, Sofia Saranti, Dimitrios Tsitsimelis, Ioannis Vrettos, Andreas Kalliakmanis
Background. The presence of ulcerative colitis (UC) with no bowel symptoms, as fever of unknown origin (FUO), is uncommon. Objective. To describe the case of an 80-year-old woman who presented with fever, with a history of UC under treatment with mesalazine. Case Presentation. She was admitted due to fever lasting for 12 days with no associated symptoms. Seven years earlier, she was diagnosed with UC. After an extended workup for FUO that failed to reach the diagnosis, she underwent a gallium-67 scintigraphy...
2016: Case Reports in Medicine
Mile Bosilkovski, Marija Dimzova, Milena Stevanović, Vesna Semenakova Cvetkovska, Maja Vasileva Duganovska
BACKGROUND/AIM: Fewer of unknown origin (FUO) remains amongst the most difficult diagnostic dilemmas in contemporary medicine. The aim of this study was to determine the causes of FU and to identify the methods of diagnosis in patients with FUO in a tertiary care setting in the Republic of Macedonia. METHODS: Retrospectively histories of 123 immunocompetent patients older than 14 years with classical FUO that had been examined at the University Hospital for Infectious Diseases and Febrile Conditions in the city of Skopje, during the period 2006-2012 were evaluated...
June 2016: Vojnosanitetski Pregled. Military-medical and Pharmaceutical Review
Sana Din, Farrukh Anwer, Mirza Beg
Fever of unknown origin (FUO) remains to be a challenge despite advancement in diagnostic technologies and procedures. FUO is considered when fever presents intermittently without an explanation. It has been linked to various etiologies, which makes it difficult to diagnose. We present the case of 18-month-old female with recurrent fever, splenomegaly, abdominal pain, and constipation. The workup for her symptoms revealed wandering spleen. Wandering spleen is a result from excessive laxity or absence of splenic ligaments...
2016: Case Reports in Pediatrics
Motoki Takeuchi, Issa J Dahabreh, Takashi Nihashi, Mitsunaga Iwata, George M Varghese, Teruhiko Terasawa
AIM: Several studies have assessed nuclear imaging tests for localizing the source of fever in patients with classic fever of unknown origin (FUO); however, the role of these tests in clinical practice remains unclear. We systematically reviewed the test performance, diagnostic yield, and management decision impact of nuclear imaging tests in patients with classic classic FUO. METHODS: We searched PubMed, Scopus, and other databases through 31 October 2015 to identify studies reporting on the diagnostic accuracy or impact on diagnosis and management decisions of fluorodeoxyglucose positron emission tomography alone (FDG-PET) or integrated with computed tomography (FDG-PET/CT), gallium scintigraphy, or leukocyte scintigraphy...
June 23, 2016: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Masaki Shimizu, Yutaka Saikawa, Akihiro Yachie
We report three patients with non-bacterial osteitis (NBO) who had fever of unknown origin (FUO) as an initial symptom. 18-Fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG-PET) can be used to detect acute inflammatory lesions. There seems to be variation among the results of (18)F-FDG-PET, a bone scan, and magnetic resonance imaging (MRI). Therefore, it would be useful to perform a bone scan to detect all lesions, combined with MRI to confirm the diagnosis of NBO, followed by (18)F-FDG-PET.
June 20, 2016: Modern Rheumatology
Junwa Kunimatsu, Junko Maeda, Riri Watanabe, On Kato, Dai Kishida, Masahide Yazaki, Akinori Nakamura
BACKGROUND: In Japan, familial Mediterranean fever (FMF) is a rare cause of fever of unknown origin (FUO). However, we experienced an extraordinary number of FMF cases over 3 years. This suggests that many patients with FMF remain misdiagnosed in Japan. This study examines the clinical picture of FMF to assist Japanese clinicians in daily practice dealing with FUO. PATIENTS AND METHODS: Three years of medical records were reviewed, and 38 patients with FMF or suspected FMF were collected from our patient database...
2016: Nihon Rinshō Men'eki Gakkai Kaishi, Japanese Journal of Clinical Immunology
Sarah S Long
The incidence and likely causes of fever of unknown origin (FUO) have changed over the last few decades, largely because enhanced capabilities of laboratory testing and imaging have helped confirm earlier diagnoses. History and examination are still of paramount importance for cryptogenic infections. Adolescents who have persisting nonspecific complaints of fatigue sometimes are referred to Pediatric Infectious Diseases consultants for FUO because the problem began with an acute febrile illness or measured temperatures are misidentified as "fevers"...
July 5, 2016: Journal of Infection
Ya-Li Chien, Fang-Liang Huang, Chung-Ming Huang, Po-Yen Chen
BACKGROUND/PURPOSE: Fever of unknown origin (FUO) can be caused by many clinical conditions and remains a diagnostic challenge in clinical practice. The etiology of FUO varies markedly among different age groups, geographic areas, and seasons. A four-stage investigative protocol for FUO is widely applied in clinical practice. The aim of this study was to evaluate the usefulness of this four-stage protocol for identifying the etiology of FUO in children. METHODS: We enrolled children younger than 18 years of age who were admitted to the Taichung Veterans General Hospital during the period from January 2006 to December 2014 with FUO persisting for more than 3 weeks...
October 9, 2015: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
Jaime M de Araújo Lobo, Christopher N Mores, Daniel G Bausch, Rebecca C Christofferson
Dengue virus (DENV) is thought to have emerged from a sylvatic cycle in Africa but has since become adapted to an urban-centric transmission cycle. These urban areas include villages in West Africa where DENV is not often routinely considered for patients presenting with febrile illnesses, as other endemic diseases (malaria, Lassa fever, e.g.) present with similar non-specific symptoms. Thus, dengue is likely under diagnosed in the region. These plaque reduction neutralization test-50 (PRNT50) screening results of patients presenting with fevers of unknown origin (FUO) at a clinic in Kenema, Sierra Leone indicate that all four serotypes of DENV likely circulate in areas surrounding Kenema...
April 2016: PLoS Neglected Tropical Diseases
Elena Verrecchia, Anna Zampetti, Daniela Antuzzi, Roberta Ricci, Lorenzo Ferri, Amelia Morrone, Claudio Feliciani, Lorenzo Dagna, Raffaele Manna
BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency of alpha-galactosidase A enzyme, which leads to the accumulation of its substrate, the globotriaosylceramide or Gb3, in many organs and tissues. Main clinical manifestations of FD are neuropathic pain, angiokeratomas, proteinuria and renal failure, left ventricular hypertrophy and stroke. Fever is also a possible symptom at the onset of the disease during childhood and adolescence, but it is frequently misdiagnosed, causing a delay in FD diagnosis...
July 2016: European Journal of Internal Medicine
Chandni R, Rajan G, Udayabhaskaran V
Disseminated tuberculosis is an important differential diagnosis for fever of unknown origin (FUO) and it can present with hepatosplenomegaly and lymphadenopathy and may have meningitis and with hematological abnormalities including pancytopenia or a leukemoid reaction. We report the case of a 13-year old male who presented with fever, weight loss, pallor and massive splenomegaly with pancytopenia, in whom a bone marrow trephine biopsy showed caseating granulomata, who responded well to antituberculous treatment and has remained healthy on follow up after nine years...
2016: IDCases
Parmod Kumar, V K Jain, Ankit Kumar, Neelesh Sindhu, Tarun Kumar, Gaurav Charaya, Surbhi, Sandeep Kumar, Divya Agnihotri, Sridhar
AIM: The present study was undertaken to ascertain the clinical observation and haemato-biochemical studies on fever of unknown origin (FUO) in buffaloes which were presented for treatment at the Teaching Veterinary Clinical Complex (TVCC), Lala Lajpat Rai University of Veterinary and Animal Sciences (LUVAS), Hisar. MATERIALS AND METHODS: The investigation was conducted on total 106 clinical cases presented at "TVCC, LUVAS, Hisar." Diseased animals having history of fever and increased rectal temperature were considered for the current study...
October 2015: Veterinary World
Rajesh Gopalarathinam, Eric Orlowsky, Ramesh Kesavalu, Sreeteja Yelaminchili
Adult onset Still's disease (AOSD) is a rare systemic inflammatory disease of unknown etiology and pathogenesis that presents in 5 to 10% of patients as fever of unknown origin (FUO) accompanied by systemic manifestations. We report an interesting case of a 33-year-old African-American male who presented with one-month duration of FUO along with skin rash, sore throat, and arthralgia. After extensive workup, potential differential diagnoses were ruled out and the patient was diagnosed with AOSD based on the Yamaguchi criteria...
2016: Case Reports in Rheumatology
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