Fever of unknown origin (FUO) due to large B-cell lymphoma: The diagnostic significance of highly elevated alkaline phosphatase and serum ferritin levels

Lortholary

The American Journal of Medicine

2015

Self Cite

106

Fevers of unknown origin remain one of the most difficult diagnostic challenges in medicine. Because fever of unknown origin may be caused by over 200 malignant/neoplastic, infectious, rheumatic/inflammatory, and miscellaneous disorders, clinicians often order non-clue-based imaging and specific testing early in the fever of unknown origin work-up, which may be inefficient/misleading. Unlike most other fever-of-unknown-origin reviews, this article presents a clinical approach. Characteristic history and physical examination findings together with key nonspecific test abnormalities are the basis for a focused clue-directed fever of unknown origin work-up.

mentioning

confidence: 99%

Fever of Unknown Origin: A Clinical Approach

Lortholary

The American Journal of Medicine

2015

Self Cite

106

Afro-Egyptian Journal of Infectious and Endemic Diseases

“…Burke and Andrew [18] found that highly elevated ESR (>100 mm/hour), highly elevated/sustained ferritin levels, highly elevated LDH and highly elevated alkaline phosphatase levels with CBC (pancytopenia, leucopenia, relative lymphopenia and thrombocytosis) suggest FUOs attributable to malignancy.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Use of Serum Ferritin Levels to Differentiate Infectious and Noninfectious Diseases in Patients with Fever of Unknown Origin

Nouh

Sebaey

Sobh³

2015

Background and study aim: Fever of unknown origin (FUO) constitutes one of the greatest challenges of clinical practice. It's defined as fever more than three weeks with fever above 38.3ºC on several occasions which remains undiagnosed after 3 days of investigations in the hospital or after three outpatient visits. Measurement of ferritin in serum is unfortunately an underutilized diagnostic test in patients with FUO. Highly elevated serum ferritin levels in patients with FUO should prompt further testing to arrive at a specific diagnosis.The aim of this study is to verify the role of serum ferritin levels in differentiation between fever of unknown origin (FUO) caused by infectious and noninfectious diseases. Patients and methods: This study included 40 patients with FUO were hospitalized at Menouf Fever Hospital between July 2013 and June 2014, and 20 volunteers of matched age and gender as a control group. According to the final diagnoses, four causes were identified, including infectious diseases, malignant diseases, collagen diseases and miscellaneous diseases. Laboratory tests, radiological examination and invasive procedures as bone marrow biopsy and lymph node biopsy were done according to cases. Serum ferritin was measured by Human Ferritin ELISA Kit. Results: Of the 40 patients, 20 were caused by infectious diseases, 10 were caused by malignant diseases, 7 were caused by collagen diseases and 3 by miscellaneous diseases (two cases of FMF and one case of drug fever). Serum ferritin levels in infectious diseases was lower than that in noninfectious diseases,where it was 457.6 ng/mL (±248.01) for the infectious disease group and1241.5 ng/mL (±1163.80) for the noninfectious diseases group. Statistically significant difference was found between the two groups (p<0.05). Conclusion: An optimal cutoff value of serum ferritin level >555 ng/mL can predict FUO caused by a noninfectious disease.

1.13 Clinical Problems - Other

“…Alkaline phosphatase (ALP) hydrolyzes phosphate esters at pH 9. The role of ALP has been investigated in other organ systems and their diseases [5,6]. The importance of alkaline phosphatase in respiratory medicine was studied previously in a limited number of studies involving tuberculous pleurisy [7,8].…”

Section: Introductionmentioning

confidence: 99%

Serum alkaline phosphatase may play a role in the differential diagnosis of sarcoidosis and tuberculosis?

Önür

Iliaz

İliaz

et al. 2016

Background: Reaching the differential diagnosis of tuberculosis and sarcoidosis can be difficult due to granulomatous inflammation. The aim of this study was to determine alkaline phosphatase (ALP) activity in serum for the differential diagnosis of tuberculosis and sarcoidosis. Methods: This study comprised 242 subjects: 105 acid-fast bacilli (AFB) positive and/or culture-positive patients with pulmonary tuberculosis, 90 patients with biopsyproven sarcoidosis and a control group consisting of 47 healthy controls were included. ALP activity was measured in serum at the first admission of the patients. Results: The mean serum ALP was 112.74±55.14 IU/L in pulmonary tuberculosis, 76.14±34.23 IU/L in sarcoidosis, and 66.87±18.49 IU/L in the control group, respectively. There was a statistically significant difference between the patient population and the control group (P = 0.03). Also, there was a statistically significant difference between the tuberculosis and sarcoidosis groups (P = 0.034). According to the comparison of tuberculosis and sarcoidosis, the cutoff value was determined as 71.50 IU/L, which had sensitivity of 80%, specificity of 51%, PPV of 66%, NPV of 69%, accuracy of 67%, and the AUC was 0.728. Conclusion: ALP, as a little-known marker for tuberculosis and sarcoidosis, was significantly increased in the pulmonary tuberculosis group compared with the sarcoidosis group. As such, it may be a useful tool for the differentiation of tuberculosis and sarcoidosis.