Fever- pyrexia of unknown origin- what to do?
Hello, my 19 year old university student was admitted to our hospital with history of high grade swinging temperature up to 39°C. She had had a sore throat, which lasted for a few days, accompanied by fever, rigors, and myalgia. Her general practitioner prescribed amoxicillin, and she subsequently developed a macular rash on her wrists, back, and legs associated with the fever spikes. The symptoms were persistent over three weeks, prompting referral to our department. She had travelled to Italy recently and recollected being bitten by mosquitoes. She had no history of recreational drug use or sexual contact and she was not taking any regular medication. Please suggest what should we do?
@kuheli When investigating a patient with pyrexia of unknown origin (PUO), consider possible aetiologies in each of the following four broad categories: infective, inflammatory, neoplastic and miscellaneous. Address each in turn. Pyrexia of unknown origin is a diagnostic challenge and early involvement of specialists is important.
The balance of causes of PUO varies over time and across different patient populations.
Investigations should be undertaken based on the most likely cause(s). Blanket investigations are not recommended as positive or equivocal tests are difficult to interpret in the absence of a suggestive exposure history and/or clinical syndrome. This can be misleading and potentially cause patient harm.
Empirical therapeutic trials are not recommended before a diagnosis is made, unless the patient is believed to have miliary tuberculosis (TB), central nervous system TB, temporal arteritis or infective endocarditis with severe sepsis.
The overall outcome of patients with a PUO is good, especially when no cause is found