FEVER OF UNKNOWN ORIGIN

  • Etiology: FUO is more commonly caused by an atypical presentation of a common disease than by a very rare disease. The most common causes of FUO can be categorized as infections, neoplasms, or noninfectious inflammatory diseases (NIIDs; e.g., “collagen or rheumatic diseases,” vasculitis syndromes, and granulomatous disorders). The frequency of each category differs between Western countries and countries in other parts of the world: infections, neoplasms, and NIIDs account for 19%, 12%, and 24% of Western cases, respectively, and for 43%, 20%, and 14% of cases in other geographic regions.
    • Atypical presentations of endocarditis, diverticulitis, vertebral osteomyelitis, and extrapulmonary tuberculosis represent the more common infectious-disease diagnoses.
    • The most common NIIDs that result in FUO are large-vessel vasculitis, polymyalgia rheumatica, sarcoidosis, familial Mediterranean fever, and adult-onset Still’s disease.
    • Among the neoplasms, malignant lymphoma is by far the most common cause of FUO. Fever occasionally precedes lymphadenopathy detectable by physical examination.

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