The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Diagnosis Can Be Elusive for Fever of Unknown Origin

Diagnosis Can Be Elusive for Fever of Unknown Origin

March 15, 2016 • By Charles Radis, DO

  • Tweet
  • Email
Print-Friendly Version / Save PDF

“Anything except prednisone,” her voice sharpened. “I once had an asthma attack, and the emergency room doctor gave me prednisone. I couldn’t sleep for a week, and my blood sugars skyrocketed. And in case you didn’t notice, I have osteoporosis. My bones are brittle enough without adding prednisone, thank you.”

You Might Also Like
  • Opinion: More Tests Needed to Diagnose Fever of Unknown Origin
  • Inflammatory Origin of Fever Is Key to Diagnosis
  • Diagnosis, Treatment for Patient with Psoriasis, Fever, Bloating, and Rash
Explore This Issue
March 2016
Also By This Author
  • Assessing Autoimmune Disease Symptoms in Silicone Breast Implant Recipients

Test Results Start Coming In

I ate lunch on the fly that day and immersed myself in the afternoon’s schedule of stable—and not-so-stable—patients. (I tapped a middle-aged man’s hot, swollen ankle and found gout crystals. Back-to-back lupus patients were doing well, a first for both of them. A rheumatoid patient was flaring, and we discussed adding a biologic, infliximab, to her background weekly methotrexate. An elderly man with unexplained headaches and muscle stiffness came in for his first visit after a biopsy of the temporal artery confirmed the diagnosis of giant cell arteritis.)

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Late in the afternoon, I noticed the lab tech had paper-clipped Mrs. N’s lab results onto her chart and placed it squarely in the center of my desk. I sat down and finished off my apple and opened a bag of Fritos. Circled in red were two particularly worrisome results: a C-reactive protein level of 19.5 mg/dL (normal: <0.8 mg/dL) and an erythrocyte sedimentation rate (ESR) of 110 (normal: <20). The CRP and ESR reflected extraordinarily high levels of inflammation, but didn’t clarify if this was due to a persistent infection, an immunologic disorder or an underlying malignancy. The results did, however, lay to rest any notion that Mrs. N was on the tail-end of a self-limited illness.

I pulled Joanne out of an adjacent exam room. “Can you call the medical center and set up an echocardiogram for Mrs. N?” Endocarditis, a life-threatening bacterial infection of a heart valve, would fit with Mrs. N’s clinical presentation. I ran my finger down the order sheet. Okay, good, I ordered blood cultures. I opened the next chart, but my mind refused to move on. Admit Mrs. N? Continue an outpatient work-up? I processed the available information—her healthy appearance, stable vitals and normal white blood count and kidney function—and decided to keep Mrs. N out of the hospital. For now.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Thankfully, Mrs. N’s blood cultures were sterile. The echocardiogram demonstrated only a slightly stiff aortic valve, but no evidence of seeding by bacteria. At her follow-up visit, she had lost three more pounds but continued to look well. I reviewed the unremarkable CT scan of the chest, an important negative, because lymph node enlargement or tumors can often be missed on a routine chest X-ray. On her lab, a normal CPK and aldolase and an anti-nuclear antibody (ANA) in the normal range made a diagnosis of myositis or lupus unlikely. Likewise, with an absent anti-neutrophil cytoplasmic antibody (ANCA) and a normal urinalysis, several rare forms of vasculitis had been ruled out.

Pages: 1 2 3 4 5 6 7 8 9 10 11 12 | Single Page

Filed Under: Conditions Tagged With: Diagnosis, fever, origin, patient care, prodrome, Rheumatic Disease, Rheumatoid arthritis, rheumatologist, Sarcoidosis, unknownIssue: March 2016

You Might Also Like:
  • Opinion: More Tests Needed to Diagnose Fever of Unknown Origin
  • Inflammatory Origin of Fever Is Key to Diagnosis
  • Diagnosis, Treatment for Patient with Psoriasis, Fever, Bloating, and Rash
  • Fellow’s Forum Case Report: Arthritis, Fever, and Weight Loss In a Teenager Suggest A Rheumatic Condition

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)