Fever of unknown origin (peds)

Background

  • Prolonged fever of unknown origin without identified cause generally has favorable prognosis.

Clinical Features

  • Original definition[1]
    • Fever >38.3 C on several occasions
    • Lasting for at least 3 weeks
    • No clear diagnosis after 1 week inpatient workup
  • Newer definition[2] - "Prolonged fever" with:
    • 3 outpatient visits without identifying a cause or
    • 3 inpatient days without identifying a cause or
    • 1 week of “intelligent and invasive” ambulatory investigation

Differential Diagnosis

  • Infection
  • Non-infectious Inflammatory
  • Malignancy
    • Leukemia
    • Lymphoma
    • Neuroblastoma
    • Wilm's tumor
  • Drug Induced
    • Antibiotics
    • Anticonvulsants
    • Anti TB
    • Procainamide
    • Quinidine
    • Serum sickness
  • Misc

Evaluation

  • Clinical (preliminary) diagnosis

Management

  • Treat underlying cause (once identified)
  • Empiric treatment generally not recommended

Disposition

  • Frequently admitted for workup

See Also

References

  1. Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.
  2. Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.

Authors:

Ross Donaldson