Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

564 Fanconi Syndrome Fever of Unknown Origin

differential diagnosis

■Autosomal recessive disorders – cystinosis, galactosemia, glycogen

storage

➣disease type I, tyrosinemia, Wilson’s disease, Lowe’s syndrome,

and hereditary fructose intolerance

■Toxins – ifosfamide, heavy metals, outdated tetracycline, aminogly-

coside, valproic acid

■Dysproteinemias such as multiple myeloma

management

n/a

specific therapy

■Therapy of underlying cause

■Vitamin D and phosphate

■Potassium and bicarbonate supplements

■May need to decrease GFR (to decrease filtered load) with indo-

methacin

follow-up

■To determine response to therapy and monitor serum electrolytes

and growth in children

complications and prognosis

■Electrolyte disorders and volume depletion

■Prognosis dependent on the cause of Fanconi syndrome

FEVER OF UNKNOWN ORIGIN

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Definition – patient with illness lasting at least 3 wks, with fever

>38.3C (101F) on several occasions, who remains undiagnosed after

3 outpatient visits or 3 days in the hospital

■Definition arbitrary, but designed to exclude patients with pro-

longed, self-limited viral illnesses, and to allow adequate time for

a cultural, serologic and radiographic evaluation

■Classification of causes:

➣Infectious (25%–40%): systemic infections: tuberculosis (usu-

ally disseminated) and endocarditis most common, but many