Fever of Unexplained Origin: Report on 100 Cases

Petersdorf, Robert G.; Beeson, Paul B.

doi:10.1097/00005792-196102000-00001

Cited by 1,082 publications

(594 citation statements)

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“…2 For example, a patient with 90 % stenosis of the left anterior descending artery, as detected on an angiogram 1 year prior, presents with a self-limited episode of chest pain. His troponin levels are undetectable, and electrocardiograms show prior Q waves in the anterior leads.…”

Section: Discussionmentioning

confidence: 99%

Sutton’s Law: Keep Going Where The Money Is

et al. 2015

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A 70-year-old Japanese man presented to a local clinic with a 3-year history of weight loss and a 2-month history of anorexia. His baseline weight was 60 kg, which had decreased to approximately 50 kg at the time of presentation. He denied fever, chills, night sweats, arthralgia, rash, diarrhea, and vomiting. His past medical history included hypertension. He was not taking any medications. The patient was a retired real estate manager. He did not drink alcohol and had quit smoking tobacco 40 years prior. He never used illegal drugs and was not sexually active. This is a 70-year-old Japanese man with 3 years of unintentional weight loss. Unintentional weight loss of nearly 15 % warrants investigation. In the present case, the duration of 3 years indicates a relatively slow process. In addition to depression, the differential diagnosis is broad, but in an elderly patient, depression and access to food should be evaluated. Because weight loss is a non-specific symptom, specific diagnostic clues should be sought through physical and laboratory examinations. It is important to determine whether the patient has had age-appropriate cancer screening.Developing an accurate problem representation is an indispensable step in the process of clinical reasoning. The problem representation at the beginning of a case, especially one in which the chief complaint is non-specific like Bweight loss,r esults in a broad differential diagnosis. The clinician acknowledges this and naturally requests additional data in an attempt to narrow the differential diagnosis.A physical exam at the local clinic revealed cachexia and normal vital signs. The heart, lung, abdominal, and lymph node exams were normal. The laboratory results are shown in Table 1. The patient had mild anemia and hypoproteinemia. As intra-abdominal diseases were suspected because of his anorexia, computed tomography (CT) and magnetic resonance imaging (MRI) scans of the abdomen revealed multiple retroperitoneal mass lesions and intra-abdominal lymph nodes 1 to 2 cm in size.

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Section: Discussionmentioning

confidence: 99%

Sutton’s Law: Keep Going Where The Money Is

et al. 2015

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“…In the 1960s, Petersdorf and Beeson conducted a prospective study at Yale University with a sample of 100 patients with body temperature above 38.3 ° C for more than 3 weeks without diagnosis, despite a week of etiological study hospitalized, coining the term "fever of unknown origin" (FOD) 1,2 ; The FOD is equivalent to the concept of prolonged febrile syndrome (PFS), which in adults maintains the 3-week temporality criterion, but in pediatrics it is currently defined as a febrile episode of at least 7-10 days of evolution, without etiological diagnosis, despite an initial study consisting of anamnesis and complete physical examination together with basic laboratory tests [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

“…As to the etiology of this syndrome, infectious, immunoreumatological, neoplastic and miscellaneous causes are distinguished [1][2][3][4] . After an exhaustive study, in 10-32% of cases, according to geographic location, no etiology is determined [2][3][4][5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Paniculitis como manifestación de síndrome febril prolongado en pediatría: Caso clínico

Silva

Radrigán

Lafuente

et al. 2017

Rev. chil. pediatr.

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Introduction: Fever of unknown origin (FUO) is defined as fever over 7 to 10 days without a diagnosis despite a complete initial study. The most frequent causes are infections, autoimmune and tumors. Even though most cases are self-limited there is a minority that has an underlying etiology with an ominous forecast, encouraging a systematized study. Objective: To report a rare case of a boy who presented fever of unknown origin associated to panniculitis and was diagnosed of subcutaneous panniculitis-like-T cell lymphoma and to emphasis the importance of a sequential study of FUO, in order to reach a diagnosis in patients who need a timely intervention. Clinical case: A ten year old boy, previously healthy, presented subcutaneous nodular lesions of 2 month of evolution, located in abdominal region and extremities, given few symptoms, associated with prolonged fever. He was hospitalized for proper study, in first instance infectious and immune causes were discarded and through lesions biopsy the diagnose of subcutaneous panniculitis-like-T cell lymphoma was reached. Conclusion: When FUO is diagnosed, most prevalent causes must be discarded. Then, differential diagnosis, such as immune and neoplasic etiologies, have to be considered. If FUO is associated to elemental nodular lesions, biopsy must be indicated early, in order to find potential malignant cases, avoiding therapeutic delay.

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“…Fever of unknown origin was first termed "prolonged and perplexing fevers" by Kiefer and Leard [1] and may be defined as disorders with temperatures greater than 38.3°C (101°F) on several occasions with a duration of fever greater than three weeks that were not diagnosed after one week of intensive in-hospital investigation [2]. Durack and Street proposed a new definition that categorizes FUO into four groups according to patient subtype, with each group having unique causes of fever [3].…”

Section: Introductionmentioning

confidence: 99%