Fever of unknown origin: A retrospective study of 52 cases with evaluation of the diagnostic utility of FDG-PET/CT

Pedersen, Thomas Ingemann; Roed, Casper; Knudsen, Lene Surland; Loft, Annika; Skinhøj, Peter; Nielsen, Susanne Dam

doi:10.3109/00365548.2011.603741

Cited by 61 publications

(77 citation statements)

References 16 publications

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“…[15][16][17][18] In several recent studies no cause could be found in a large proportion of patients (Table 1). 3,5,[19][20][21] Lower incidences of specifi c infections, such as tuberculosis and brucellosis, and differences in availability of modern imaging techniques, such as CT, MRI and FDG-PET/CT, may among others cause these differences.…”

Section: Defi Nition and Causesmentioning

confidence: 99%

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Fever of unknown origin

2015

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Fever of unknown originMore than 50 years after the fi rst defi nition of fever of unknown origin (FUO), it still remains a diagnostic challenge. Evaluation starts with the identifi cation of potential diagnostic clues (PDCs), which should guide further investigations. In the absence of PDCs a standardised diagnostic protocol should be followed with PET-CT as the imaging technique of fi rst choice. Even with a standardised protocol, in a large proportion of patients from western countries the cause for FUO cannot be identifi ed. The treatment of FUO is guided by the fi nal diagnosis, but when no cause is found, antipyretic drugs can be prescribed. Corticosteroids should be avoided in the absence of a diagnosis, especially at an early stage. The prognosis of FUO is determined by the underlying cause. The majority of patients with unexplained FUO will eventually show spontaneous remission of fever. We describe the defi nition, diagnostic workup, causes and treatment of FUO. Defi nition and causesFever of unknown origin (FUO) was fi rst defi ned by Petersdorf and Beeson in 1961, who defi ned FUO as body temperature above 38.3°C (101°F) on three or more occasions and a duration of illness of at least three weeks, in which no diagnosis was made after one week of hospital admission. 1 In the following years this defi nition was modifi ed. Immunocompromised patients are now excluded, 2 as these patients have other etiologies of FUO and need a different therapeutic approach. To refl ect the increasing outpatient-based healthcare it was suggested to shorten the duration of investigation to three inpatient days or three outpatient visits. 2 However, as investigations in three outpatient visits and three inpatient days cannot be compared, different causes of FUO will be found in admitted patients. Instead of using arbitrary quantitative time criteria, a quantitative criterion of obligatory investigations was implemented in the defi nition. [3][4][5] The current defi nition of FUO is: ABSTRACT > temperature ≥38.3°C (101°F) on at least two occasions > duration of illness ≥3 weeks or multiple febrile episodes in ≥3 weeks > not immunocompromised (neutropenia for ≥1 week in the 3 months prior to the start of the fever; known HIVinfection; known hypogammaglobulinemia or use of 10 mg prednisone or equivalent for ≥2 weeks in the 3 months prior to the start of the fever) > Diagnosis uncertain despite thorough history-taking, physical examination and the following investigations: erythrocyte sedimentation rate or C-reactive protein, haemoglobin, platelet count, leukocyte count and differentiation, electrolytes, creatinine, total protein, protein electrophoresis, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase, antinuclear antibodies, rheumatoid factor, microscopic urinalysis, ferritin, three blood cultures, urine culture, chest X-ray, abdominal ultrasonography and tuberculin skin test.

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Section: Defi Nition and Causesmentioning

confidence: 99%

“…21 Up to 75% of patients experience spontaneous remission of fever, although this may take a long time. 4,5,15,20 Treatment with NSAIDs or corticosteroids increases this proportion even further. 5 …”

Section: Prognosismentioning

confidence: 99%

Fever of unknown origin

2015

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“…However, detecting the cause of FUO is still challenging. 18 F-Fluorodeoxyglucose ( 18 F-FDG) PET has been used as an aid in the diagnosis of FUO patients for the past 10-15 years [3]. Studies have reported the application of 18 F-FDG PET/CT in the diagnosis of FUO with varying results.…”

Section: Introductionmentioning

confidence: 99%

“…18 F-Fluorodeoxyglucose ( 18 F-FDG) PET has been used as an aid in the diagnosis of FUO patients for the past 10-15 years [3]. Studies have reported the application of 18 F-FDG PET/CT in the diagnosis of FUO with varying results. One study reported a high false-positive rate [4], whereas another study reported that 18 F-FDG PET was reliable in diagnosing the cause of FUO [5]; yet another study reported that 18 F-FDG PET/CT had a high negative predictive value (100%) for evaluation of FUO [6].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have reported the application of 18 F-FDG PET/CT in the diagnosis of FUO with varying results. One study reported a high false-positive rate [4], whereas another study reported that 18 F-FDG PET was reliable in diagnosing the cause of FUO [5]; yet another study reported that 18 F-FDG PET/CT had a high negative predictive value (100%) for evaluation of FUO [6]. The aim of this study was to systematically review and conduct a meta-analysis of published data on the diagnostic role of 18 F-FDG PET/CT in FUO patients.…”

Section: Introductionmentioning

confidence: 99%

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