| Evaluation of fever of unknown origin and predictors for malignant disease |
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Seong Yeol Ryu, Sang Taek Heo, Ki Tae kwon, Won Sup Oh, Kyong Ran Peck, Jae Hoon Song |
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고려대학교 의과대학 내과학교실 |
| 원저:불명열 환자의 원인 질환 및 악성종양 예측인자에 대한 분석 |
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류성열, Sang Taek Heo, Ki Tae kwon, Won Sup Oh, Kyong Ran Peck, Jae Hoon Song |
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| Abstract |
Background : Fever of unknown origin (FUO) remains a challenging problem despite recent
advances in diagnostic modalities. The spectrum of disease causing FUO seems to change with time
as well as geographical factors. To evaluate the causes of FUO and identify important trends, a
retrospective study was performed.
Methods
: All adult patients with FUO admitted to the hospital from January 1995 to August 2005
were included. The criteria for diagnosis of FUO were adopted from Durack and Street.
Results
: A total of 148 patients (mean age, 42.5 years ; M : F, 70 : 78) were enrolled. Of these,
116 (79%) patients were finally diagnosed with one of the following etiologies: infectious disease
(37%), connective tissue disorders (16%), malignancy (14%), and miscellaneous disorders (12%)
including Kikuchi's disease, factitious fever, drug-related fever and thyroiditis. Lymphoma (14%)
was the most common cause of FUO, followed by tuberculosis (12.8%) and adult-onset Still's disease
(6.8%). An older age (>50 years), thrombocytopenia, lower CRP level and splenomegaly were
predictive factors for malignant disease.. However, 31 patients (21%) did not fit a definite diagnosis
despite intensive investigation. Moreover, the proportion (26%) of undiagnosed patients during the
period of 2000～2005 was significantly higher than that (13%) during the period of 1995～1999
(p<0.044).
Conclusions
: Although infectious disease remains a major cause of FUO, lymphoma was
identified as the most common disease entity. The presence of older age, thrombocytopenia, lower
CRP and splenomegaly were predictive of malignant disease and therefore require intensive
diagnostic work-up.(Korean J Med 71:302-308, 2006)
Key Words : Fever of unknown origin, Lymphoma, Tuberculosis |
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