Internal Medicine

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

Fever of Unknown Origin 567

often done; liver biopsy helpful in 5–10% of patients with abnormal

LFTs

■Role of laparoscopy and laparotomy unclear, but should be consid-

ered in rapidly deteriorating patient with negative evaluation

differential diagnosis

■As indicated above

management

■Documentation of fever critical initial step as evaluation long, costly

and potentially invasive

■If suspect factitious fever, observe patient while taking temperature

■Have patient record temperature 3 or 4 times a day for several days

to assess frequency, height and periodicity.

specific therapy

■If specific diagnosis made, therapy directed at underlying cause

■Empiric therapy indicated if a specific diagnosis strongly suspected;

before therapy started, all relevant cultures should be obtained; end-

points should be set prior to therapy – if no clinical response after

several weeks, therapy should be discontinued and re-evaluation

undertaken

■In the rapidly deteriorating patient, empiric therapy indicated:

antituberculous therapy (particularly in the elderly or those from

endemic areas) and broad-spectrum antibiotics reasonable

■Steroids to suppress fever not indicated; infection the most common

cause of FUO, and steroids may allow infections to become more

aggressive or disseminate

follow-up

■In undiagnosed patients, careful and frequent (weekly) follow-up

indicated to assess any new signs or symptoms that may lead to a

diagnosis

complications and prognosis

■Prognosis depends on underlying disease; the elderly and those with

malignancy have less favorable outcome

■Of those undiagnosed after extensive evaluation, 75% eventually

have resolution of symptoms and etiology remains unknown; in the

remainder, more classic signs and symptoms of underlying disease

appear, allowing a specific diagnosis to be made

■Death from FUO is uncommon, occurring in less than 5%.