Mesenteric Panniculitis Presenting as Fever of Unknown Origin

A 40-yr-old man was admitted for fever of unknown origin. Mesenteric panniculitis was suspected as a result of Ultrasonography, computed tomography, and nuclear magnetic resonance findings, and that diagnosis was confirmed by laparoscopy with retroperitoneal mass biopsy. Mesenteric panniculitis is a rare disease characterized by an inflammatory process of the mesenteric adipose tissue. Abdominal pain, weight loss, and abdominal mass are the most frequent symptoms. High fever and leukocytosis are uncommon. To the best of our knowledge, only two reports of mesenteric panniculitis presenting as fever of unknown origin have been described previously, with no cases published in the English literature. In the case reported, steroid therapy was started with initial improvement. Despite the temporary addition of azathioprine and the maintenance of the prednisone treatment, no further improvement has been achieved. Two years and 5 months after admission, the patient presents intermittent episodes of fever and muscle pain.     

Mesenteric Fibromatosis Presenting as Fever of Unknown Origin

We report a case of fibromatosis, soft tissue tumors that are benign histologically, but exhibit behavior intermediate between benign and malignant diseases. Mesenteric fibromatosis grows vigorously without a general inflammatory reaction, and its symptoms are the result of obstruction and/or compression of the intestine. However, in our case, the general inflammatory reactions of fever and C-reactive protein (CRP) elevation was present at an early stage. Because this inflammatory reaction disappeared after surgical resection, it may have been induced by some inflammatory factors produced in the tumor, such as those produced in inflammatory fibrous histiocytoma. We found that computed tomography was useful in the detection of the cause of fever of unknown origin, and suggest that it should be recommended in cases of long-lasting unexplainable fever.     

Delayed Diagnosis of Biopsy-Negative Giant Cell Arteritis Presenting as Fever of Unknown Origin

Fever of unknown origin (FUO) presents a diagnostic challenge. Giant cell arteritis (GCA) may present with FUO and this entity should be included in the differential of elderly patients who present with constitutional symptoms. While a temporal artery biopsy is considered the gold standard for the diagnosis of GCA, a subset of patients with large vessel involvement by GCA may have a negative temporal artery biopsy and no cranial symptoms. We present a 79 year-old woman with FUO and negative temporal artery biopsies in whom diagnosis of GCA was delayed. Further imaging with CT-angiogram and positron emission tomography/computed tomography (PET/CT) scan showed diffuse extensive active vasculitis. The above case underscores the value of imaging studies in the evaluation of patients with FUO from occult large vessel vasculitis.     

Fever of Unknown Origin in Taiwan

Abstract Background: Fever of unknown origin (FUO) is a challenging problem worldwide. There was no prospective study of FUO in the past two decades in Taiwan. A prospective study was conducted. Materials and Methods: The prospective study was undertaken from March 2001 to May 2002. All patients fulfilling the modified criteria for FUO, either admitted, referred or consulted in a medical center in southern Taiwan, were enrolled for analysis. Results: A total of 94 cases met the criteria of FUO. The final diagnoses of FUO consisted of 54 infectious diseases (57.4%), 8 hematologic/neoplastic (8.5%), 7 noninfectious inflammatory (7.4%), 8 miscellaneous (8.5%) and 17 undiagnosed (18.1%) cases. The single most common cause of FUO was tuberculosis. Some infectious diseases, such as rickettsiosis and melioidosis, were rarely reported in western countries. Three patients with hemophagocytotic syndrome without ascertainable etiologies were present with FUO in this study. Between the patients with and those without a final diagnosis, the short-term survival (3 months) was compared by the Kaplan–Meier analysis, which revealed no difference. Conclusions: Mycobacteriosis is still the leading cause of FUO in Taiwan and it is important to identify this treatable disease from all causes of FUO. This study has showed geographical variation among the studies of FUO.     

Fever of Unknown Origin in Turkey

Abstract. Background: The etiology of fever of unknown origin (FUO) includes primarily infectious, collagen-vascular and neoplastic diseases. The distribution of the disorders causing FUO may differ according to the geographic area and the socioeconomical status of the country. Moreover, the developments in radiographic and microbiologic methods have changed the spectrum of diseases causing FUO. Materials and Methods: We reviewed 117 cases that fulfilled the criteria of FUO followed in our department during the period 1984 to 2001. Results: The etiology of FUO was infectious diseases in 34% of the patients, collagen-vascular diseases in 23%, neoplasms in 19% and miscellaneous diseases in 10%. In 14% of the cases the etiology could not be found. The three leading diseases were tuberculosis (24%), lymphomas (19%) and adult-onset Stills disease (11%). Tuberculosis was found to be a more common cause of FUO than reported in studies in developed countries. Invasive procedures helped to establish the diagnosis in 50 out of 92 patients (43%). As a final diagnostic procedure, laparotomy aided the establishment of a diagnosis in 15 out of 20 patients (75%). Conclusion: Although the relative rate of infectious disease as etiologic category is less commonly encountered, infectious disease, especially tuberculosis, remains a common cause of FUO. Although several diseases may lead to FUO, lymphomas, adult-onset Stills disease and particularly tuberculosis should be considered in the differential diagnosis of a patient admitted with FUO.     

Tuberculosis of the Colon in a Kidney Transplant Patient

ABSTRACT A 58-year-old woman experienced recurrent fever episodes after kidney transplantation. She was treated with antibiotics because of suspicion of staphylococcus infection. Abdominal pain combined with haemorrhagic diarrhoea occurred eight months after transplantation. A barium enema revealed a stenotic process in the middle part of the ascending colon mimicking carcinoma, and hemicolectomy was consequently performed. Histological examination revealed tuberculosis with little granuloma formation and abundant acid-fast tubercle bacilli in the mucosa and submucosa, and only slight perigranulomatous reactions. The patient was successfully treated with triple antituberculous chemotherapy without deterioration of allograft function. Tuberculosis should be suspected in immuno-suppressed patients suffering from pyrexia of unknown origin, even when chest X-ray is normal.     

Giant Cell Arteritis (Temporal Arteritis) Presenting as Fever of Undetermined Origin

A retrospective study of the histories of 100 patients with biopsy-proven giant cell arteritis was performed. Fifteen of these patients had “fever of unknown origin” as the initial manifestation of this disease. All 15 had normal leukocyte counts; however, they had significantly lower hemoglobulin and albumin levels (P > 0.01) and significantly higher platelet counts, erythrocyte sedimentation rates, and alkaline phosphatase values (P ∼ 0.05) compared to the other 85 patients. In 4 patients, random temporal artery biopsies were performed despite persistently negative results from diagnostic evaluations and in the absence of any symptoms or findings suggestive of arteritis.     

Disseminated Histoplasmosis Presenting as Weight Loss and Hypercalcemia in a Renal Transplant Patient With Prior History of Subtotal Parathyroidectomy

Hypercalcemia and weight loss in a renal transplant patient especially with history of parathyroidectomy raises concern for an underlying malignancy, fungal infections or granulomatous disease. We present a case of 45-year-old male with history of subtotal parathyroidectomy presented with severe persistent hypercalcemia, acute kidney injury (AKI) and significant weight loss. An extensive workup revealed disseminated histoplasmosis. Hypercalcemia (which was refractory to initial medical management) and other symptoms resolved after a few weeks of initiating the antifungal treatment.