Abstract
Fever of unknown origin (FUO) remains one of the most difficult diagnostic challenges. The causes of FUO can be various diseases located in different organs. The aim of the study was to determine the prevalence and nature of pulmonary lesions during FUO. One hundred and sixty one patients with FUO participated in this prospective study. We performed a detailed comprehensive history, physical examination, and a wide spectrum of tests. The most common causes of FUO were infections (39%), autoimmune conditions (28%), and neoplasms (17%). Lung lesions were found in 30% of patients. In this group 35% were infections, 30% autoimmune diseases, and 4% cancer. Among patients with respiratory infections, there were cases of tuberculosis, atypical pneumonia, lung abscess, and bronchiectases. Autoimmune pulmonary lesions were observed during vasculitis and systemic lupus. The causes of FUO in the group of patients with lung lesions were also pulmonary embolism, sarcoidosis, and pulmonary fibrosis. Chest CT played an important role in the diagnosis of the causes of FUO with pulmonary manifestations. Pulmonary lesions are a common cause of FUO. Most FUO with pulmonary lesions are recognized during infections and autoimmune diseases. An important part of diagnosing FUO is a detailed evaluation of the respiratory system.
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AbuRahma AF, Saiedy S, Robinson PA, Boland JP, Cottrell DJ 4th, Stuart C (1997) Role of venous duplex imaging of the lower extremities in patients with fever of unknown origin. Surgery 121:366–371
Akar H, Ozbasli-Levi C, Senturuk T, Kadikoylu G, Levi E, Bolaman Z (2002) MPO-ANCA associated small vessel vasculitis presenting as fever of unknown origin. Report of one case. Nephron 92:673–675
Altenburg J, Wortel K, van der Werf TS, Boersma WG (2015) Non-cystic fibrosis bronchiectasis: clinical presentation, diagnosis and treatment, illustrated by data from a Dutch Teaching Hospital. Neth J Med 73:147–154
Arnow PM, Flaherty JP (1997) Fever of unknown origin. Lancet 350:575–580
ATS (2000) Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. American Thoracic Society (ATS), and the European Respiratory Society (ERS). Am J Respir Crit Care Med 161:646–664
ATS/ERS/WASOG (1999) Statement on sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 16:149–173
Augustynowicz-Kopeć E, Demkow U, Grzelewska-Rzymowska I, Korzeniewska-Koseła M, Langfort R, Michałowska-Mitczuk D, Rowińska-Zakrzewska E, Zielonka TM, Ziołkowski J, Zwolska Z (2013) Guidelines of Polish Respiratory Society concerning diagnosis, treatment and prevention of tuberculosis in adults and in child. Pneumonol Alergol Pol 81:325–379
Baicus C, Bolosiu HD, Tanasescu C, Baicus A (2003) Fever of unknown origin-predictors of outcome. A prospective multicenter study on 164 patients. Eur J Intern Med 14:249–254
Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, Smilde TJ, Krabbe PF, Oyen WJ, van der Meer JW (2007) A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore) 86:26–38
Brown KK (2006) Pulmonary vasculitis. Proc Am Thorac Soc 3:48–57
Chalmers JD, Aliberti S, Blasi F (2015) Management of bronchiectasis in adults. Eur Respir J 45:1446–1462
Chiles C (2002) Imaging features of thoracic sarcoidosis. Semin Roentgenol 37:82–93
Cunha BA (1996) Fever of unknown origin. Infect Dis Clin N Am 10:111–127
Cunha BA (2007a) Fever of unknown origin. Clinical overview of classic and current concepts. Infect Dis Clin N Am 21:867–915
Cunha BA (2007b) Fever of unknown origin in malignancies. In: Cunha BA (ed) Fever of unknown origin. Informa Healthcare, New York, pp 27–34
Cunha BA, Parchuri S, Mohan S (2006) Fever of unknown origin: temporal arteritis presenting with persistent cough and elevated serum ferritin levels. Heart Lung 35:112–116
Cunha BA, Pherez FM, Katz DS (2010) Fever of unknown origin (FUO) due to a solitary cavitary lung lesion: the deadly ferritin-laced doughnut. Heart Lung 39:340–344
Cunha BA, Lortholary O, Cunha CB (2015) Fever of unknown origin: a clinical approach. Am J Med 128:1138.e1–1138.e15. doi:10.1016/j.amjmed.2015.06.001
Durack DT, Street AC (1991) Fever of unknown origin – reexamined and redefined. Curr Clin Top Infect Dis 11:35–51
Jasper N, Dabritz J, Frosch M, Loeffler M, Weckesser M, Foell D (2010) Diagnostic value of (18F)-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation. Eur J Nucl Med Mol Imaging 37:136–145
Kim MS, Koh JS, Baek HJ, Ryoo BY, Kim CH, Lee JC (2007) Neoplastic fever caused by lung cancer. J Thorac Oncol 2:158–159
Kluge MJ (2015) Fever: its biology, evolution, and function. Princeton University Press, Princeton
Knockaert DC, Dujardin KS, Bobbaers HJ (1996) Long-term follow-up of patients with undiagnosed fever of unknown origin. Arch Intern Med 156:618–620
Kubota K, Nakamoto Y, Tamaki N, Kanegae K, Fukuda H, Kaneda T, Kitajima K, Tateishi U, Morooka M, Ito K, Minamimoto R, Murakami K (2011) FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study. Ann Nucl Med 25:355–364
Kucukardali Y, Oncul O, Cavuslu S, Danaci M, Calangu S, Erdem H, Topcu AW, Adibelli Z, Akova M, Karaali EA, Ozel AM, Bolaman Z, Caka B, Cetin B, Coban E, Karabay O, Karakoc C, Karan MA, Korkmaz S, Sahin GO, Pahsa A, Sirmatel F, Solmazgul E, Ozmen N, Tokatli I, Uzun C, Yakupoglu G, Besirbellioglu BA, Gul HC, Fever of Unknown Origin Study Group (2008) The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study. Int J Infect Dis 12:71–79
Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D (2015) Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med 3:183
Lambin C, Bergoin C, Saelens T, Wallaert B (2001) Interstitial lung disease in collagen vascular disease. Eur Respir J 18(Suppl 32):69s–92s
Mañá J, Gomez-Vaquero C, Montero A, Salazar A, Marcoval J, Valverde J, Manresa F, Pujol R (1999) Löfgren’s syndrome revisted: a stady of 186 patients. Am J Med 107:240–245
Mansueto P, Di Lorenzo G, Rizzo M, Di Rosa S, Vitale G, Rini G, Mansueto S, Affronti M (2008) Fever of unknown origin in a Mediterranean survey from a division of internal medicine: report of 91 cases during a 12-year-period (1991–2002). Intern Emerg Med 3:219–225
Meller J, Sahlmann CO, Scheel AK (2007) 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med 48:35–45
Mert A, Ozaras R, Tabak F (2003) Fever of unknown origin: a review of 20 patients with adult-onset Still’s disease. Clin Rhematol 22:89–93
Millet A, Pederzoli-Ribeil M, Guillevin L, Witko-Sarsat V, Mouthon L (2014) Antineutrophil cytoplasmic antibody-associated vasculitides: is it time to split up the group? Postgrad Med J 90:290–296
Moawad MA, Bassil H, Elsherif M, Ibrahim A, Elnaggar M, Edathodu J, Alharthi A, Albugami M, Sabry A, Shoukri M, Bakhsh I, Laudon U (2010) Fever of unknown origin: 98 cases from Saudi Arabia. Ann Saudi Med 30:289–294
Mourad O, Palda V, Detsky AS (2003) A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 163:545–551
Muñoz-Gómez S, Cunha BA (2015) Fever of unknown origin (FUO) due to Legionnaire’s disease. Heart Lung 44:72–74
NICE (2014) Pneumonia in adults: diagnosis and management. Clinical guideline (CG191) Published date: December 2014 https://www.nice.org.uk/guidance/cg191. Accessed on 14 Jan 2017
Petersdorf RG, Beeson PB (1961) Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 40:1–30
Seshadri N, Solanki CK, Balan K (2008) Utility of 111In-labeled leukocyte scintigraphy in patients with fever of unknown origin in an era of changing disease spectrum and investigational techniques. Nucl Med Commun 29:277–282
Sica S, Avino S, Glielmi G, Cicero SR (1999) Incidence of fever of difficult diagnosis observed from January 1990 to August 1998. Infez Med 7:96–104. (Article in Italian)
Sood R, Agarwal V, Mukhopadhyay S (1997) Tuberculosis mediastinal adenopathy presenting as fever of unknown origin. Lancet 350(9093):1782
Sørensen HT, Mellemkjaer L, Skriver MV, Johnsen SP, Nørgård B, Olsen JH, Baron JA (2005) Fever of unknown origin and cancer: a population-based study. Lancet Oncol 6:851–855
Tal MH, Guller V, Gurevich A (2007) Fever of unknown origin in older adults. Clin Geriatr Med 23:649–668
Tanoue LT, Mark EJ (2003) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 1-2003: a 43-year-old man with fever and night sweats. N Engl J Med 348:151–161
Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Durnez A, Blockmans D, Bobbaers H (2003) From prolonged febrile illness to fever of unknown origin: the challenge continues. Arch Intern Med 163:1033–1041
Verschakelen JA (2005) Sarcoidosis: imaging features. In: Drent M, Costabel U (eds) Sarcoidosis. Eur Respir Mono 10:265–283
Welker L, Jörres RA, Costabel U, Magnusen H (2004) Predictive value of BAL cell differentials in the diagnosis of interstitial lung diseases. Eur Respir J 24:1000–1006
Zee YK, Soo RA (2010) Non-small cell lung cancer presenting with neoplastic fever at diagnosis and relapse. Int J Infect Dis 14:e518–e521
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The authors thank Ms. Natalie Czaicki for the English revision of the manuscript.
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Krupa, R., Zielonka, T.M., Hadzik-Blaszczyk, M., Wardyn, K.A., Zycinska, K. (2017). Lung Lesions During Fever of Unknown Origin. In: Pokorski, M. (eds) Clinical Management of Pulmonary Disorders and Diseases. Advances in Experimental Medicine and Biology(), vol 1022. Springer, Cham. https://doi.org/10.1007/5584_2017_37
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DOI: https://doi.org/10.1007/5584_2017_37
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