the lancet vol 350 23 aout 1997

Causes of FUO


Intra abdominal abscess teg, peri appendiceal, diverticular, subphrenic); liver, splenic, pancreatic, perinephric, psoas, or placental abscess

Appendicitis, cholecystitis, cholangitis, aortoenteric fistula, mesenteric lymphadenitis, tubo-ovarian abscess, pyometra

Intracranial abscess, sinusitis, mastoiditis, otitis media, dental abscess

Chronic pharyngitis, tracheobronchitis, lung abscess

Septic jugular phlebitis, mycotic aneurysm, endocarditis, intravenous catheter infection, vascular graft infection

Wound infection, osteomyelitis, infected joint prosthesis, pyelonephritis, prostatitis

Tuberculosis, Mycobacterium avium complex, leprosy, Lyme disease, relapsing fever t60rrelia recurrentis), syphilis, Q fever,

legionellosis, yersiniosis

Salmonellosis ( including typhoid fever), listeriosis, Campylobacter, brucellosis, tularaemia, bartonellosis, ehrlichiosis, psitticosis,

Chlamydia pneumoniae, murine typhus, scrub typhus

Gonococcaemia, meningococcaemia

Actinomycosis, nocardiosis, melioidosis, Whipple's disease t Tropheryma whippe/i')

Candidaemia, cryptococcosis, histoplasmosis, coccodioidomycosis, blastomycosis, sporotrichosis, aspergillosis, mucormycosis,

Malassezia furfur. Pneumocystis carinii

Visceral leishmaniasis. malaria, babesiosis, toxoplasmosis, schistosomiasis, fascioliasis, toxocariasis, amoebiasis, infected

hydatid cyst, trichinosis. trypanosomiasis

Cytomegalovirus, HIV, Herpes simplex, Epstein.Barr virus, parvovirus B19


FUO bas been reported in association with aIl common malignant diseases.

Collagen vascular disease

Adult Still's disease, SLE, cryoglobulinaemia, Reiter's syndrome. rheumatic fever, giant cell arteritis/polymyalgia rheumatica,

wegener's granulomatosis, ankylosing spondylitis, Behçet's syndrome, polyarteritis nodosa 1

Hypersensitivity vasculitis, urticarial vasculitis, SjOgren's syndrome, polymyositis, rheumatoid arthritis, erythema multiforme, ,

erythema nodosum, relapsing polychondritis, mixed connective-tissue disease, Takayasu's aortitis, Weber.Christian disease,

Felty's syndrome, eosinophilic fasciitis


Haematoma, thrombosis, recurrent pulmonary embolism, aortic dissection, femoral aneurysm, post.myocardial infarction

syndrome, atrial myxoma

i Drug fever, Sweet's syndrome, familial Mediterranean fever, familial Hibernian fever, hyperimmunoglobulin D syndrome

Crohn's disease, ulcerative colitis, sarcoidosis, granulomatous hepatitis

Subacute tde Quervain's) thyroiditis, hyperthyroidism, adrenal insufficiency. primary hyperparathyroidism, hypothalamic

hypopituitarism, autoimmune haemolytic anaemia

Gout, pseudogout

Cirrhosis, chronic active hepatitis, alcoholic hepatitis, shunt nephritis

Malacoplakia, Kawasaki's syndrome, Kikuchi's syndrome

Mesenteric fibromatosis, inflammatory pseudotumour

Castleman's disease, Vogt.Koyanagi.Harada syndrome, Gaucher disease, Schnitzler's syndrome, FAPA syndrome tfever, aphthous

stomatitis, pharyngitis, adenitis), Fabry' 5 disease

Cholesterol emboli, silicone embolisation, Teflon embolisation

Lymph node infarction, sickle cell disease vasoocclusive crisis, anhidrotic ectodermal dysplasia, cyclic neutropenia, Brewer's

yeast ingestiM, Hamman.Rich syndrome

Milk protein allergy, hypersensitivity pneumonitis, extrinsic allergic alveolitis, metal fume fever, polymer fume fever, idiopathic

hypereosinophilic syndrome

Complex partial status epilepticus, cerebrovascular accident, brain tumour, encephalitis

Anomalous thoracic duct, psychogenic fever, habituaI hyperthermia, factitious illness

* ldentified in case.reports and case series published during 1961-97

THE LANCET 576 Vol 350 . August 23, 1997

: Minimum diagnostic evaluation to quallify as FUO

Comprehensive history

Repeated physical examination

Complete blood count, including differential and platelet count

Routine blood chemistry, including lactate dehydrogenase, bilirubin, and liver enzymes

Urinalysis, including microscopic exmination

Chest radiograph

Erythrocyte sedimentation rate

Antinuclear antibodies

Rheumatoid factor

Angiotensin converting enzyme

Routine blood cultures l x3) while not receiving antibiotics

Cytomegalovirus IgM antibodies or virus detection in blood

Heterophile antibody test in children and young adults

Tuberculin skin test

CT of abdomen or radionuclide scan

Further evaluation of any abnormalities detected by above tests