PDF(Pubmed)
Abstract：
Fever of unknown origin (FUO) is defined as a fever higher than 38.3ºC for at least three weeks. It remains a difficult diagnostic challenge and it carries well over 200 differential diagnoses, including infectious, rheumatologic and malignant etiologies. A methodological approach with clinical deductive reasoning and value-based investigative work-up can establish the diagnosis. This case is about a 76-year-old male with a past medical history of atrial fibrillation, bladder cancer treated with chemotherapy (now in remission) and hydronephrosis with recent ureteropelvic junction stent placement. He presented to the emergency department (ED) for worsening shortness of breath (SOB), weakness, and fevers. His initial workup was notable for a urinary tract infection which was treated with ceftriaxone. However, there was only a limited improvement in the fever. Diagnostic imaging was negative on initial review. He was evaluated by consultants of different specialities including infectious disease, rheumatology, and hematology. Ultimately, the decision was made to discharge the patient home on steroids with further outpatient workup. He returned four weeks later with worsening fever and was found to have new-onset mediastinal lymphadenopathy. A biopsy of an inguinal lymph node was obtained which showed high grade-B cell lymphoma. The patient was continued on prednisone and started on chemotherapeutic agents which included vincristine, rituximab and cyclophosphamide. Shortly after starting treatment, the patient and family elected for hospice. This case demonstrates the importance of continuously questioning the diagnosis at hand and of keeping an open mind when evaluating a patient with FUO.
摘要：
不明原因发热（FUO）被定义为发烧超过38.3ºC至少三周。它仍然是一个艰难的诊断挑战，它有超过200个鉴别诊断，包括传染性,风湿病和恶性病因。具有临床演绎推理和基于价值的调查工作的方法学方法可以建立诊断。这个病例是关于一名76岁的男性，有房颤病史，接受化疗的膀胱癌（目前处于缓解期）和肾积水，近期输尿管肾盂连接部支架置入治疗。他因呼吸急促（SOB）恶化而向急诊科（ED）提出，弱点,和发烧。他的最初检查值得注意的是用头孢曲松治疗的尿路感染。然而,发烧只有有限的改善。初次复查诊断影像学检查阴性。他接受了包括传染病在内的不同专业的顾问的评估，风湿病,和血液学。最终,决定将患者使用类固醇出院回家，并进行进一步的门诊检查。四周后，他因发烧恶化而返回，并被发现患有新发纵隔淋巴结病。获得腹股沟淋巴结活检，显示高度B细胞淋巴瘤。患者继续使用泼尼松，并开始使用包括长春新碱在内的化学治疗剂，利妥昔单抗和环磷酰胺。开始治疗后不久，病人和家属选择了临终关怀。此案例表明，在评估FUO患者时，必须不断质疑手头的诊断并保持开放的心态。
