lucky_doc
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An otherwise healthy 25 yo medical student presents to the ED with a 2 week history of chills, fever, and malaise. His PE reveals a fever of 101F and stable VS with no other abnormal findings. Urine, blood, and sputum cultures are taken and all are negative for growth. The patient is admitted for observation and further testing, yet after a week no explanation is found. Which of the following is the most likely cause of a fever in this patient?
A Collagen vascular disease
B Granulomatous disease
C Infection
D Neoplasm
E Pulmonary emboli
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| brutus25
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C- Infection is the mcc overall , probably milliary TB
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| RX 135
Forum Guru
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pyrexia of unknown origin...nfections (30-40%),neoplasms (20-30%)collagen vascular diseases (10-20%),numerous miscellaneous diseases (15-20%
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| RX 135
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c
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| Adam
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ya, it's C
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| drshvetasm
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c
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| farnsworth
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C
blood cultures are positive in 30% of patients having an infection.
TB is a very good guess. Suggestion: do a CT thorax, you will either see the caverns/calcifications or a Ghon complex. Other possibilities: fungal infections, they tend to be overseen in sputum cultures (takes time to grow!), do a galactomannan test. Check for atypical pneumonia (mycoplasma, chlamydia psitacci, CMV, HSV, cocciodiosis, legionella, pneumocystis etc).
Rule out endocarditis, frequently overseen cause of fever (and no: the sensitivity and specifity of auscultation is not very high for valvular defects due to high interoperator variability, ambient noise during auscultation etc)
If not focus for infection found: CT of the head (sinusitis?), abdominal CT (abscess?), rule out DVT!
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| Korotkoff
Forum Senior
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I will say D. I don't know the reason. I just felt like it.
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| hero
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RX 135 wrote:
pyrexia of unknown origin...nfections (30-40%),neoplasms (20-30%)collagen vascular diseases (10-20%),numerous miscellaneous diseases (15-20%
but if you will eliminate infections bcs growth is negative after 2 wks of fever/malaise
Edited by hero on 01/25/08 - 10:10 AM
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| arlete
Intern in 2009!!!!!
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I think it's C. If she has IE on the right side of the heart, for example, the cultures will be negative. Many situations in infection have negative cultures.
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| hero
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arlete wrote:
I think it's C. If she has IE on the right side of the heart, for example, the cultures will be negative. Many situations in infection have negative cultures.
in two wks probably would be some change in vitals..
i'm reasoning why it could be not infection. 
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| Ivonne
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Fever of Unknown Origin
Can Mr. C's fever be classified as a fever of unknown origin (FUO)? The answer is yes. The classic definition of a FUO is a temperature greater or equal to 38oC on multiple occasions for greater than 3 weeks, persisting without diagnosis after 2 outpatient visits, or after 3 days in the hospital.[3]
Following the definition of an FUO, Dr. Brust reminded the audience that the "most enduring concept related to FUO is that the underlying disease is more likely to represent a relatively common illness presenting in an atypical manner than a truly rare problem."
Based on the above instead of looking for the zebra i will pick the horse---------->C
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| lucky_doc
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The answer indeed is C well done guys
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