Fever of unknown origin (FUO) due to miliary BCG: The diagnostic importance of morning temperature spikes and highly elevated ferritin levels

Cunha, Burke A.; Apostolopoulou, Anna; Gian, John

doi:10.1016/j.hrtlng.2017.01.009

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Tuberculosis presenting as FUO can be difficult to diagnose due to commonly nonspecific signs and symptoms [25,32,33]. This study found high positive predictive value and high likelihood ratio of a positive test for previous tuberculosis or tuberculosis exposure in the infectious category.…”

Section: Discussionmentioning

confidence: 62%

“…Bleeker-Rovers et al [14] considered weight loss as a clue with diagnostic value in FUO patients. It is well known that weight loss can be a remarkable clinical finding in common neoplastic or infectious causes of FUO such as malignant lymphomas, tuberculosis, subacute bacterial endocarditis and HIV infection [10,[21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic utility of clinical and epidemiologic features in fever of unknown origin

Campañá

Paneque

Silva

2019

The European Research Journal

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Objectives: To assess the diagnostic utility of clinical features in the major diagnostic categories of Fever of unknown origin (FUO). Methods: One hundred and thirty-three patients meeting the classic criteria of FUO were included in the study. A structured diagnostic protocol was used in all cases. Sensitivity, specificity, positive and negative predictive values (PPV and NPVs), and likelihood ratios of positive and negative tests (LR+ and LR-) were estimated with 95% confidence intervals (95% CIs) for all clinical findings. Results: Clinical and epidemiologic features with best diagnostic utility indexes for the three major diagnostic categories were: weight loss of 15 pounds or more (

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of clinical and epidemiologic features in fever of unknown origin

Campañá

Paneque

Silva

2019

The European Research Journal

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“…4 Imaging plays a key role in the diagnosis of miliary TB and, as in the present case, CT findings guided the diagnosis, even when microbiological and histopathological evidence of mycobacterial infection were negative. 6 In this case, a presumptive diagnosis of disseminated BCG infection was justified by the clinical presentation consistent with active TB, associated with radiological findings consistent with miliary dissemination of Mycobacterium tuberculosis and high ferritin levels, commonly reported amongst pulmonary TB patients 7 ; finally, the evidence of mycobacterial genome by PCR confirmed the diagnosis.…”

Section: Discussionmentioning

confidence: 68%

“…Miliary TB as a manifestation of pulmonary involvement of BCG infection is very rare, and only a very few cases have been reported thus far. 1,5,6,7 Although its pathogenesis remains incompletely understood, some authors consider pulmonary BCGitis to be a type of hypersensitivity reaction as serological tests and cultures are negative in approximately 60% of cases. However, some case reports support the theory of haematogenous spread from an active mycobacterial infection based on the isolation of mycobacteria or the detection of its genome by PCR, as in this case.…”

Section: Discussionmentioning

confidence: 99%

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

Brandi¹,

Bartalena²,

Mosconi³

et al. 2021

South African Journal of Radiology

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Intravesical instillation of Bacillus Calmette-Guérin (BCG) is used as an adjuvant treatment of bladder cancer. Systemic BCG infection occurs in less than 1% of cases, and pulmonary involvement is even rarer (0.3% – 0.7%), with a favourable prognosis. A 78-year-old male developed miliary tuberculosis (TB) secondary to intravesical BCG treatment and subsequent coronavirus disease 2019 (COVID-19) superinfection that led to patient death. High awareness amongst clinicians is needed to proceed with immediate appropriate therapy in these patients, especially during the COVID-19 pandemic

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“…4 It can be disseminated, or present in virtually any organ, including atypical pulmonary manifestations. 5 Therefore, it is always the foremost diagnosis in the minds of our clinicians.…”

Section: Discussionmentioning

confidence: 99%

Pyrexia of unknown origin and its aetiology in Pakistan

Waheed¹,

Awan²,

Ishaq

et al. 2022

Trop Doct

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Pyrexia of unknown origin (PUO) and its aetiology vary considerably according to geography. We conducted a retrospective study to update our knowledge of PUO in Pakistan. PUO was defined as a febrile illness of >3 weeks’ duration, a temperature of >38.3°C, and >3 outpatient visits or 3 days’ hospitalization. Infection was the cause in 47.1%, malignancy in 23.1%, noninfectious inflammatory disease in 21.8%, miscellaneous causes in 1.2%, and in 6.8%, the cause of the fever was not found.

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Fever of unknown origin (FUO) due to miliary BCG: The diagnostic importance of morning temperature spikes and highly elevated ferritin levels

Cited by 5 publications

References 16 publications

Diagnostic utility of clinical and epidemiologic features in fever of unknown origin

Diagnostic utility of clinical and epidemiologic features in fever of unknown origin

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

Pyrexia of unknown origin and its aetiology in Pakistan

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