Polyarteritis nodosa presenting as a pyrexia of unknown origin

A case of an 18 year old woman is reported who presented with a pyrexia of unknown origin having returned from a trip to India. She initially had constitutional symptoms only, which rapidly progressed to a multisystem disorder. The difficulty in making the diagnosis of polyarteritis nodosa, especially with the possible differential diagnosis of infection after her recent travel, is discussed. The discussion reviews the condition of polyarteritis nodosa and analyses the diagnostic difficulties in this case.     

Ovarian carcinoma presenting as pyrexia of unknown origin

A patient with a poorly differentiated clear cell adenocarcinoma of the ovary presenting as pyrexia of unknown origin is reported. Following resection of the tumour, her pyrexia resolved completely.     

Haemophagocytic syndrome presenting as pyrexia of unknown origin

Haemophagocytic syndrome (HPS) should be included in the differential diagnosis of pyrexia of unknown origin (PUO). The hallmark of HPS is the accumulation of activated macrophages that engulf haematopoietic cells in the reticuloendothelial system. We describe a patient with unexplained fever in which a final diagnosis of HPS was established in a bone marrow study.     

Splenic tuberculosis presenting as pyrexia of unknown origin

We report a case of a previously healthy 38-year old lady who presented with prolonged fever and hepatosplenomegaly. Intensive investigations were performed for pyrexia of unknown origin which revealed negative. CT scan of the abdomen showed multiple hypodense lesions which did not respond to broad-spectrum antibiotics. Percutaneous biopsy of the splenic lesion revealed granuloma formation and Langhan's giant cells suggestive of TB. She responded well with anti- TB medication but required extended treatment duration of 24 months due to persistence of the splenic lesion on repeated CT scans. This case illustrates a very rare clinical entity of isolated splenic TB with a therapeutic dilemma following incomplete resolution, despite prolonged treatment.     

Graves' disease presenting as pyrexia of unknown origin

Fever is a common clinical manifestation of inflammatory processes of the thyroid and thyroid crisis. On the other hand, fever alone as a presenting symptom of thyrotoxicosis, without other manifestations, is extremely rare. A female patient is described in whom fever persisted for two months prior to hospitalization, but without clinical symptoms or signs to lead to suspicion of thyroid disease. After exhaustive investigation it was found that the patient was suffering from hyperthyroidism. Fever disappeared gradually on antithyroid therapy, recurred when the drugs were withdrawn for a rechallenge trial, and cleared up again after renewal. Four other cases of persistent fever as a presenting symptom of hyperthyroidism were found on a review of previous publications. Thyrotoxicosis should, therefore, be included in the differential diagnosis of pyrexia of unknown origin.     

Group B streptococcal infection in neonates.

A study of 866 vaginal swabs from non-pregnant women showed that 167 (19.3%) contained Group B beta-haemolytic streptococci, with a predominance of Types 3 (31.4%) and Ib (25.2%). The incidence of severe neonatal infections due to Group B streptococci during a 3 1/2 year period at The Prince of Wales Hospital was examined, and a study was made of the distribution of serotypes and associated clinical features (including prematurity and abnormal deliveries) in 16 neonates with septicaemia and/or meningitis admitted to the Royal Alexandra Hospital for Children, and the Paediatric Department of The Prince of Wales Hospital. From this study it was concluded that prophylactic antibiotic therapy should be administered to neonates with evidence of Group B streptococcal colonization of the throat, umbilicus, or gut, when there is also evidence of prematurity, prolonged interval between membrane rupture and delivery, or other associated obstetric complications.     

Dental infection as the cause of pyrexia of unknown origin--two case reports

Two cases of pyrexia of unknown origin are described in which no cause was found despite exhaustive inpatient investigation until occult dental infection was detected: extraction of the teeth involved was followed by resolution of the pyrexia. Dental infection should be considered as an unusual but eminently treatable cause of pyrexia of unknown origin.     

Sinonasal natural killer/T-cell lymphoma presenting as pyrexia of unknown origin with nasal symptoms

A 68-year-old Chinese man presented with an eight-month history of pyrexia of unknown origin and chronic sinusitis despite multiple courses of antibiotics. He underwent extensive investigations, including workups for infections, chronic granulomatous diseases and malignancy. Nasal biopsies were performed twice under local anaesthesia, but did not show any evidence of malignancy. Eventually, the patient was diagnosed with natural killer (NK)/T-cell lymphoma, nasal variant, based on histopathological findings from harvested deep tissue obtained via functional endoscopic sinus surgery. This study highlights that, for patients presenting with pyrexia of unknown origin and nasal symptoms, NK/T-cell lymphoma must be considered as a differential diagnosis. Generous amounts of tissue should be harvested under general anaesthesia rather than limited tissue under local anaesthesia, in order to facilitate and ensure a definitive diagnosis.     

An unusual case of pyrexia of unknown origin with cervical lymphadenopathy

Kikuchi's disease is usually a self limiting illness characterised by pyrexia, neutropenia, and cervical lymphadenopathy particularly in young women of Asian descent. This often leads to an initial misdiagnosis of lymphoma. A case of a young Asian woman who presented with pyrexia of unknown origin is described.     

Group B streptococcal endocarditis

Group B Streptococcus can cause early onset neonatal disease. Beyond neonatal life, group B Streptococci are unusual pathogens. It can cause septicemia, epiglottis, fascitis, and endocarditis. A male Saudi child with group B endocarditis who has congenital heart disease is discussed.     

Group B streptococcal meningitis in a diabetic adult

A rare case of adult group B streptococcal meningitis is presented. The association with diabetes mellitus is emphasized and attention is drawn to microscopic and serological confusion that may arise in differentiating it from pneumococcal meningitis.