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1.
J Assoc Physicians India ; 69(10): 11-12, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34781653

RESUMO

OBJECTIVES: Fever of unknown origin (FUO) has different etiology in different age groups. We aimed to determine the spectrum of FUO in older patients and to establish the underlying etiology. METHODS: This was a hospital-based prospective observational study conducted between January 2018 to June 2019 at Postgraduate Institute of Medical Education and Research, Chandigarh, India. Fifty-one consecutive patients aged 60 years and above met the qualitative criteria of FUO. RESULTS: The etiological distribution was infections in 21 patients (41.2%), malignancies in 16 (31.4%) and noninfectious inflammatory disorders in 8 (15.7%). Six patients (11.8%) remained undiagnosed. Among infections, 15 patients (29.4%) had tuberculosis, and 10 had an extrapulmonary disease. Twelve out of 16 cases with malignancies had a hematological cause, and eight had lymphoma. ;Regarding decisive methods of diagnosis, 18F-fluorodeoxyglucose positron emission tomography was diagnostic in 17 out of 27 patients (63%) and computed tomography in 21 out of 42 cases (50%). Imaging or endoscopy-guided procedures provided a diagnostic clue in 12 out of 14 patients (85.7%), and bone marrow examination results were useful in 9 out of 19 (47.4%). CONCLUSIONS: Infections and malignancies contributed to about three-fourths of cases, with tuberculosis and lymphoma being the commonest etiologies.


Assuntos
Febre de Causa Desconhecida , Idoso , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/etiologia , Fluordesoxiglucose F18 , Humanos , Índia/epidemiologia , Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Tomografia Computadorizada por Raios X
4.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413039

RESUMO

We present the case of a 20-year-old man with a background of transposition of the great arteries presenting with fever of unknown origin, who developed a shock like syndrome with respiratory failure necessitating intubation. After extensive investigation, a diagnosis of adult-onset Kawasaki disease was made, and he was successfully treated with IVIg and corticosteroids. We present the clinical findings clinicians should be aware of, and review the literature on managing this rare presentation in adult, highlighting the importance of early diagnosis in improving outcomes. Both children and adults with Kawasaki disease require long-term follow-up, as they remain at increased risk of both coronary artery aneurysms and early acute coronary syndrome.


Assuntos
Aneurisma Coronário , Febre de Causa Desconhecida , Síndrome de Linfonodos Mucocutâneos , Transposição dos Grandes Vasos , Adulto , Criança , Aneurisma Coronário/diagnóstico por imagem , Febre de Causa Desconhecida/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Adulto Jovem
5.
Ann Hematol ; 100(11): 2813-2824, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34387741

RESUMO

Patients treated for adult T-Cell leukemia/lymphoma (ATL) have a poor prognosis and are prone to infectious complications which are poorly described. As the French reference center for ATL, we retrospectively analyzed 47 consecutive ATL (acute, n = 23; lymphoma, n = 14; chronic, n = 8; smoldering, n = 2) patients between 2006 and 2016 (median age 51 years, 96% Afro-Caribbean origin). The 3-year overall survival (OS) was 15.8%, 11.3%, and 85.7% for acute, lymphoma, and indolent (chronic and smoldering) forms respectively. Among aggressive subtypes, 20 patients received, as frontline therapy, high dose of zidovudine and interferon alfa (AZT-IFN⍺) resulting in an overall response rate (ORR) of 39% (complete response [CR] 33%) and 17 chemotherapy resulting of an ORR of 59% (CR 50%). Ninety-five infections occurred in 38 patients, most of whom had an acute subtype (n = 73/95; 77%). During their follow-up, patients receiving frontline chemotherapy or frontline AZT-IFNα developed infections in 74% (n = 14/19) and 89% (n = 24/27) of the cases respectively. Sixty-four (67%) of infections were microbiologically documented. Among them, invasive fungal infections (IFI, n = 11) included 2 Pneumocystis jirovecii pneumonia, 5 invasive aspergillosis, and 4 yeast fungemia. IFI exclusively occurred in patients with acute subtype mostly exposed to AZT-IFNα (n = 10/11) and experiencing prolonged (> 10 days) grade 4 neutropenia. Patients with aggressive subtype experiencing IFI had a lower OS than those who did not (median OS 5.4 months versus 18.4 months, p = 0.0048). ATL patients have a poor prognosis even in the modern era. Moreover, the high rate of infections impacts their management especially those exposed to AZT-IFNα.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Interferon-alfa/efeitos adversos , Infecções Fúngicas Invasivas/etiologia , Leucemia-Linfoma de Células T do Adulto/tratamento farmacológico , Zidovudina/efeitos adversos , Adolescente , Adulto , Idoso , Antibioticoprofilaxia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Aspergilose/epidemiologia , Aspergilose/etiologia , Neutropenia Febril/complicações , Feminino , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/etiologia , Fungemia/epidemiologia , Fungemia/etiologia , Humanos , Interferon-alfa/administração & dosagem , Infecções Fúngicas Invasivas/epidemiologia , Estimativa de Kaplan-Meier , Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/mortalidade , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/etiologia , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/etiologia , Prevalência , Prognóstico , Estudos Retrospectivos , Estrongiloidíase/epidemiologia , Estrongiloidíase/etiologia , Estrongiloidíase/prevenção & controle , Resultado do Tratamento , Adulto Jovem , Zidovudina/administração & dosagem
6.
Arch Dis Child ; 106(11): 1047-1049, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34407957

RESUMO

OBJECTIVE: To evaluate the impact of introducing the Step-by-Step approach on care quality in young febrile infants. DESIGN: Observational study including infants ≤90 days old with fever without source seen in a paediatric emergency department 5 years before (n=1222) and after (n=1151) its introduction. Quality of care was evaluated in terms of adherence to recommendations, resource use and safety. RESULTS: Adherence: percentages of infants undergoing both urine and blood tests and infants <15 days old receiving full sepsis evaluation increased (84.7% vs 91.0% and 23.9% vs 63.3%, respectively; p<0.01). Resource use: lumbar puncture and admission rates decreased (24.1% vs 18.7% and 43.6% vs 38.3%, respectively; p<0.01), while the rate of antibiotic therapy increased (30.2% vs 43.2%; p<0.01). SAFETY: the invasive bacterial infection rate among infants managed as outpatients was unchanged (0.7% vs 0.3%; p=0.24). CONCLUSION: The introduction of the Step-by-Step increased the quality of care provided to young febrile infants.


Assuntos
Infecções Bacterianas/complicações , Febre de Causa Desconhecida/diagnóstico , Fidelidade a Diretrizes/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Sepse/etiologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/sangue , Infecções Bacterianas/líquido cefalorraquidiano , Infecções Bacterianas/urina , Feminino , Febre de Causa Desconhecida/etiologia , Fidelidade a Diretrizes/ética , Diretrizes para o Planejamento em Saúde , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribuição , Humanos , Lactente , Recém-Nascido , Masculino , Admissão do Paciente/estatística & dados numéricos , Medicina de Emergência Pediátrica/estatística & dados numéricos , Estudos Prospectivos , Segurança , Sepse/diagnóstico , Punção Espinal/estatística & dados numéricos
7.
Artigo em Inglês | MEDLINE | ID: mdl-34069883

RESUMO

Fever of unknown origin (FUO) poses a diagnostic challenge, and 18-fluorodexoyglucose positron emission tomography with computed tomography (18FDG-PET/CT) may identify the source. We aimed to evaluate the diagnostic yield of 18FDG-PET/CT in the work-up of FUO. The records of patients admitted to Sheba Medical Center between January 2013 and January 2018 who underwent 18FDG-PET/CT for the evaluation of FUO were reviewed. Following examination of available medical test results, 18FDG-PET/CT findings were assessed to determine whether lesions identified proved diagnostic. Of 225 patients who underwent 18FDG-PET/CT for FUO work-up, 128 (57%) met inclusion criteria. Eighty (62.5%) were males; mean age was 59 ± 20.3 (range: 18-93). A final diagnosis was made in 95 (74%) patients. Of the 128 18FDG-PET/CT tests conducted for the workup of FUO, 61 (48%) were true positive, 26 (20%) false positive, 26 (20%) true negative, and 15 (12%) false negative. In a multivariate analysis, weight loss and anemia were independently associated with having a contributary results of 18FDG-PET/CT. The test yielded a sensitivity of 70%, specificity of 37%, positive predictive value of 70%, and negative predictive value of 37%. 18FDG-PET/CT is a valuable tool in the diagnostic workup of FUO. It proved effective in diagnosing almost half the patients, especially in those with anemia and weight loss.


Assuntos
Febre de Causa Desconhecida , Fluordesoxiglucose F18 , Adulto , Idoso , Febre de Causa Desconhecida/diagnóstico por imagem , Febre de Causa Desconhecida/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
8.
J Pak Med Assoc ; 71(5): 1489-1492, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091642

RESUMO

Fever of unknown origin (FUO) presents a major diagnostic challenge as it is a consequence of many infectious as well as malignant, rheumatologic and other diseases. Here we present the case of a woman with mediastinal and abdominal lymphadenopathy who was initially suspected to have lymphoproliferative disease, but our histopathologic examination revealed sarcoidosis. Sarcoidosis, especially chronic, is a rare cause of FUO, because it usually manifests as a febrile condition. A woman presented with shoulder and ankle joint pain, mediastinal and abdominal lymphadenopathy and fever at the Infectious Diseases Clinic. Physical examination identified the presence of lupus pernio and normal respiratory noise in the lungs, and later peripheral lymphadenopathy. Peripheral blood smear indicated conspicuous eosinophilia. Biopsy examination obtained by rigid bronchoscopy suggested pulmonary sarcoidosis. Sarcoidosis and lymphoma may have similar clinical manifestations; both present as mediastinal and abdominal lymphadenopathy with constitutional symptoms. Therefore, in the diagnosis of sarcoidosis, it is important to exclude lymphoproliferative diseases and other granulomatous diseases.


Assuntos
Doenças Transmissíveis , Febre de Causa Desconhecida , Linfadenopatia , Linfoma , Feminino , Febre de Causa Desconhecida/etiologia , Humanos , Linfadenopatia/diagnóstico , Linfadenopatia/etiologia , Mediastino
9.
Andes Pediatr ; 92(2): 210-218, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34106159

RESUMO

INTRODUCTION: Acute fever of unknown origin (FUO) in children under 29 days is a worrying situation because of the risk of serious bacterial infection (SBI). OBJECTIVE: to study the main clinical and laboratory characteristics of a group of hospitalized children under 29 days with diagnosis of FUO. PATIENTS AND METHOD: Retrospective study of children under 29 days hospitalized due to FUO. The clinical records of the patients were reviewed, recording age, sex, history of fever before consultation, temperature at admission, estimated severity at admission and discharge, discharge diagnoses, laboratory tests, and indicated treatments. Patients were classified according to the severity of the discharge diagnosis, as severe (S) and non-severe (NS). The inclusion criteria were term newborn, age less than 29 days, fe ver > 38°C registered at home or admission, and history of < 4 days. RESULTS: 468 children with FUO were admitted. Concordance between severity at admission and discharge was low (Kappa = 0.125; p = 0.0007). 26.1% of children were S and 73.9% NS. In the S group, urinary tract infection domínate (70.5%) and in the NS, FUO (67.6%). The cut-off levels for leukocytes/mm3, C-reactive protein, and neutrophils/mm3 showed negative predictive values to rule out severe bacterial infection. Conclu sions: Most of the newborns presented mild severity at admission, but 24% of them had SBI, thus hospitalization and close clinical observation are always necessary. Laboratory tests, such as CRP, white blood cell and neutrophils count are not good predictors of SBI. Early treatment with antibio tics for patients who meet the low-risk criteria is debatable.


Assuntos
Infecções Bacterianas/complicações , Febre de Causa Desconhecida/etiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Proteína C-Reativa/análise , Chile/epidemiologia , Feminino , Febre de Causa Desconhecida/sangue , Febre de Causa Desconhecida/epidemiologia , Humanos , Recém-Nascido , Pacientes Internados/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Neutrófilos/citologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia
10.
BMJ Case Rep ; 14(5)2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34045206

RESUMO

A 40-year-old woman presented with fever of unknown origin (FUO) for 2 months. Without a definitive diagnosis and having received multiple empirical antibiotics from outside without relief, she was referred to our centre. Cardiac auscultation was remarkable for a grade 3/6 continuous murmur in the upper left sternal border. Echocardiogram revealed a patent ductus arteriosus (PDA) and a 5×7 mm mobile vegetation at the pulmonary artery bifurcation. Blood culture grew Streptococcus mutans. Embolisation of the vegetation to the pulmonary circulation occurred after the start of intravenous antibiotics resulting in fever relapse. Antibiotics were continued for 6 weeks and the fever settled. She underwent device closure of PDA after 12 weeks and is currently doing fine. Infective endocarditis/endarteritis is an important differential in a patient of FUO. A thorough clinical examination is important in every case of FUO, gives an important lead into diagnosis and guides appropriate investigations to confirm it.


Assuntos
COVID-19 , Permeabilidade do Canal Arterial , Endarterite , Febre de Causa Desconhecida , Adulto , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/diagnóstico por imagem , Endarterite/diagnóstico , Feminino , Febre de Causa Desconhecida/etiologia , Humanos , Pandemias , SARS-CoV-2
11.
Am J Emerg Med ; 48: 249-254, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34000525

RESUMO

Fever of unknown origin (FUO) is defined as persistent fevers without an identifiable cause despite extensive medical workup. Emergency physicians caring for patients reporting a persistent, nonspecific, febrile illness should carefully consider potentially serious non-infectious causes of FUO. We present a case of a 35-year-old man who presented to the emergency department (ED) three times over a 10-day period for persistent febrile illness and was ultimately diagnosed with Adult-Onset Still's Disease (AOSD) after a serum ferritin level was found to be over 42,000 µg/L. AOSD, along with macrophage activation syndrome, catastrophic antiphospholipid syndrome, and septic shock comprise the four hyperferritinemic syndromes. These are potentially life-threatening febrile illnesses that characteristically present with elevated ferritin levels. In this article, we highlight the value of a serum ferritin level in the workup of a patient with prolonged febrile illness and its utility in facilitating early diagnosis and prompt treatment of hyperferritinemic syndromes in the ED.


Assuntos
Febre de Causa Desconhecida/fisiopatologia , Hiperferritinemia/sangue , Doença de Still de Início Tardio/diagnóstico , Adulto , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/complicações , Serviço Hospitalar de Emergência , Febre de Causa Desconhecida/etiologia , Humanos , Hiperferritinemia/etiologia , Síndrome de Ativação Macrofágica/sangue , Síndrome de Ativação Macrofágica/complicações , Masculino , Choque Séptico/sangue , Choque Séptico/complicações , Doença de Still de Início Tardio/sangue , Doença de Still de Início Tardio/complicações , Doença de Still de Início Tardio/fisiopatologia
12.
Rev Med Suisse ; 17(734): 738-743, 2021 Apr 14.
Artigo em Francês | MEDLINE | ID: mdl-33852209

RESUMO

Despite the diagnostic means currently available, fever of unknown origin (FUO) remains a diagnostic challenge for the practitioner, requiring a detailed and systematic approach. The etiologies can be classified into 4 main groups: infectious diseases, systemic inflammatory diseases, neoplasia and various rarer entities such as drug-induced or endocrine fevers. A non-negligible percentage of FUOs remains without a clear etiology, generally with a spontaneously favorable evolution. In this article, we propose an algorithm for a step-by-step diagnostic approach and highlight clues that can lead to a diagnosis. However, clinical judgment remains the main pillar in the proposed approach in order to avoid futile investigations.


Assuntos
Doenças Transmissíveis , Febre de Causa Desconhecida , Neoplasias , Doenças Transmissíveis/diagnóstico , Diagnóstico Diferencial , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Humanos , Neoplasias/diagnóstico
15.
BMJ Case Rep ; 14(3)2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771775

RESUMO

Fever of unknown origin (FUO) has a broad differential diagnosis, including infectious, inflammatory and malignant aetiologies. Granulomatosis with polyangiitis (GPA) can present with non-specific symptoms, including fever, lethargy and flu-like illness. While systemic vasculitis causing FUO has been well-documented, GPA as an underlying cause for FUO poses a diagnostic and therapeutic challenge for clinicians. We present the case of a 65-year-old man who presented to the emergency department with a report of fever, myalgia and night sweats for greater than 3 weeks. After an extensive workup, the patient was diagnosed with GPA and he eventually responded to corticosteroids and immunosuppressive therapy. This case aims to raise awareness of FUO secondary to GPA and serves as a reminder to clinicians that early recognition and prompt treatment of this syndrome improves patient outcomes.


Assuntos
Febre de Causa Desconhecida , Granulomatose com Poliangiite , Corticosteroides , Idoso , Diagnóstico Diferencial , Febre de Causa Desconhecida/etiologia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Masculino
16.
BMJ Case Rep ; 14(3)2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692045

RESUMO

Peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is a relatively rare condition in Australia. Here, we report a case of PTCL, NOS in a patient who presented with persistent fever and progressive pancytopenia on a background of mediastinal lymphadenopathy, initially presumed reactive and hepatosplenomegaly with deranged liver function tests. The diagnosis was challenging, with multiple negative blood cultures and inconclusive bone marrow studies, and it required extensive investigations that ultimately revealed the characteristic clinical, histopathological and immunophenotypic features of PTCL, NOS. The patient underwent multiple rounds of multiagent chemotherapy after the diagnosis. This case highlights the difficulty in diagnosing PTCL, NOS and the importance of including it as a differential diagnosis in younger patients who present with constitutional symptoms and hepatosplenomegaly.


Assuntos
Febre de Causa Desconhecida , Linfoma de Células T Periférico , Pancitopenia , Austrália , Febre de Causa Desconhecida/etiologia , Humanos , Testes de Função Hepática , Linfoma de Células T Periférico/complicações , Linfoma de Células T Periférico/diagnóstico , Masculino , Pancitopenia/etiologia
17.
Int J Clin Pract ; 75(6): e14138, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33683769

RESUMO

AIMS: The differential diagnosis of Fever of Unknown Origin (FUO) is still a major clinical challenge despite the advances in diagnostic procedures. In this multicentre study, we aimed to reveal FUO aetiology and factors influencing the final diagnosis of FUO in Turkey. METHODS: A total of 214 patients with FUO between the years 2015 and 2019 from 13 tertiary training and research hospitals were retrospectively evaluated. RESULTS: The etiologic distribution of FUO was infections (44.9%), malignancies (15.42%), autoimmune/inflammatory (11.68%) diseases, miscellaneous diseases (8.41%) and undiagnosed cases (19.62%). Brucellosis (10.25%), extrapulmonary tuberculosis (6.54%) and infective endocarditis (6.54%) were the most frequent three infective causes. Solid malignancies (7.1%) and lymphoma (5.6%), adult-onset still's disease (6.07%) and thyroiditis (5.14%) were other frequent diseases. The aetiological spectrum did not differ in elderly people (P < .05). Infections were less frequent in Western (34.62%) compared with Eastern regions of Turkey (60.71%) (P < .001, OR: 0.31, 95% Cl: 0.19 to 0.60). The ratio of undiagnosed aetiology was significantly higher in elderly people (p: 0.046, OR: 2.34, 95% Cl: 1.00 to 5.48) and significantly lower in Western Turkey (P: .004, OR: 3.07, 95% Cl: 1.39 to 6.71). CONCLUSIONS: Brucellosis, extrapulmonary tuberculosis and infective endocarditis remain to be the most frequent infective causes of FUO in Turkey. Solid tumours and lymphomas, AOSD and thyroiditis are the other common diseases. The aetiological spectrum did not differ in elderly people, on the other hand, infections were more common in Eastern Turkey. A considerable amount of aetiology remained undiagnosed despite the state-of-the-art technology in healthcare services.


Assuntos
Febre de Causa Desconhecida , Doença de Still de Início Tardio , Adulto , Idoso , Ásia , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/etiologia , Humanos , Estudos Retrospectivos , Turquia/epidemiologia
18.
Vnitr Lek ; 67(1): 32-42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33752399

RESUMO

Fever of unknown origin is a rare clinical syndrome, that represents a significant diagnostic challenge. There have been described more than 200 potential diseases, that can manifest as a fever of unknown origin. These are classically divided into following categories: infections, non-infectious inflammatory diseases, malignancies, and other miscellaneous disorders. Each of the disease type is associated with rather characteristic symptoms, clinical signs and laboratory findings, which are individually non-specific, but may provide helpful clues for a further focused diagnostic work-up. The clinicians task is to be able to identify these hallmark clinical features and to correctly interpret their significance and limitations in the appropriate differential diagnostic context. The aim of this review is to provide up-to-date clinical research evidence and to propose a  concise clue-oriented diagnostic approach.


Assuntos
Febre de Causa Desconhecida , Neoplasias , Diagnóstico Diferencial , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Humanos , Neoplasias/complicações
19.
Spinal Cord Ser Cases ; 7(1): 19, 2021 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-33712553

RESUMO

INTRODUCTION: Discovering the source of a patient's fever, in the absence of clinical localizing signs, can be a formidable undertaking. Without a clear symptom pattern to narrow the focus of a diagnostic workup, this task can require numerous noninvasive and invasive procedures, imaging studies, and laboratory tests to arrive at a conclusion. Identifying the source of a patient's fever in the setting of an acute spinal cord injury can present a unique challenge because this population is at risk for many different conditions that can cause fever, some of which are rarely seen in the general population. CASE PRESENTATION: This case report describes a unique case and diagnostic workup of fever of unknown origin in a 51-year-old male with multiple medical comorbidities who presented to an inpatient rehabilitation service following an acute traumatic cervical spinal cord injury. Ultimately, it was determined that the patient had several different factors that were causing him to have intermittent fevers over a 5-week period. DISCUSSION: This case demonstrates the importance of obtaining serial medical histories and physical examinations during the investigation for fever of unknown origin. It also supports why additional workup of a patient's fever may need to be considered even after a potential source is found. Finally, it demonstrates the need for increased awareness of quadriplegic fever so that this condition can be more effectively recognized, prevented, and managed in the future.


Assuntos
Febre de Causa Desconhecida , Traumatismos da Medula Espinal , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico
20.
Chest ; 159(1): e25-e28, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33422236

RESUMO

CASE PRESENTATION: A 49-year-old man presented with 3 months of persistent fever, cough, shortness of breath, and chest tightness. He had no response to treatment with antibiotics. He had been treated with an empiric 2-week course of steroids approximately 2 months before presentation, with mild and transient improvement. He did not use tobacco and had not experienced any weight loss, hemoptysis, arthralgia, or myalgia, and was otherwise in good health. He denied contact with anyone with pulmonary TB or other respiratory illnesses.


Assuntos
Tosse/etiologia , Febre de Causa Desconhecida/etiologia , Policondrite Recidivante/complicações , Policondrite Recidivante/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Policondrite Recidivante/terapia
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