pyrexia of unknown origin on IDU

Question 1

what are the classical definitions of pyrexia of unknown origin?

Answer 1

• temp >38 on multiple occasions
• illness >3 weeks duration
• no diagnosis despite >1 week worth of inpatient

Question 2

what are the common infective causes of pyrexia of unknown origin ?

Answer 2

Infective –
tuberculosis,
abscesses,
infective endocarditis, brucellosis

Question 3

what are the common autoimmune/CT causes of pyrexia of unknown origin?

Answer 3

adult onset Still’s disease, temporal arteritis, Wegener’s granulomatosis

Question 4

what are the common neoplastic causes of pyrexia of unknown origin?

Answer 4

leukaemias, lymphomas, renal cell carcinoma

Question 5

what are the less likely causes of pyrexia of unknown origin?

Answer 5

drugs
thromboembolism
hyperthyroidism
adrenal insufficiency

Question 6

what should be checked for in an examination of PUO?

Answer 6

lymph nodes
stigmata of endocarditis
evidence of weight loss
joint abnormalities

Question 7

what are the key management points in a patient with pyrexia of unknown origin?

Answer 7

• Aim to establish the diagnosis, rather than treating blindly
• Do NOT start empirical antibiotics/steroids/antifungals without speaking to a senior
• We often ask rheumatology and haematology to see PUO patients, depending on the presentation.
• Try and stay up to date on what tests have been done – a front sheet for the notes is very helpful
• Stable patients can be managed as outpatients following a period of observation in hospital
• In patients with no diagnosis despite prolonged investigation, the prognosis tends to be good

Question 8

what thinks can be asked specifically in the history of a patient with PUO?

Answer 8

Chronology of symptoms? Pets/animal exposure?Travel?
Occupation?
Medications?
Family history?
Vaccination history?
Sexual contacts?