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Rinsho Shinkeigaku 2022 Jun 24. Epub 2022 Jun 24.

Department of Neurology, Nagaoka Red Cross Hospital.

A 23-year-old woman, who had been suffering from migraine since primary school age, presented with left arm paralysis three days after one such migraine attack. On admission, brain MRI diffusion-weighted imaging (DWI) demonstrated high-signal-intensity lesions in the white matter of the right fronto-parietal lobe, and no abnormal lesions were evident in the limbic system. Although the patient had a fever of 38. Read More

J Antimicrob Chemother 2022 Jun 24. Epub 2022 Jun 24.

Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, Nantes, France.

Background: Early antibiotic discontinuation according to the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations is not systematically applied in high-risk neutropenic patients with haematological malignancies.

Methods: A retrospective multicentre observational study was conducted over 2 years to evaluate the safety of early antibiotic discontinuation for fever of unknown origin (FUO) during neutropenia after induction chemotherapy or HSCT, in comparison with a historical cohort. We used Cox proportional hazards models, censored on neutropenia resolution, to analyse factors associated with febrile recurrence. Read More

J Geriatr Oncol 2022 Jun 16. Epub 2022 Jun 16.

Departments of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address:

Introduction: Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer.

Materials And Methods: Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Read More

PET Clin 2022 Jul;17(3):533-542

Division of Diagnostic Nuclear Medicine, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address:

The role of nuclear medicine for noninvasive assessment of infection and inflammation is well established. The role of nuclear medicine is limited to initial diagnosis, recurrence, and response assessment of infections and inflammations such as tuberculosis, sarcoidosis, vasculitis, osteomyelitis, immunoglobulin G4-related diseases, and coronavirus disease 2019, as the specificity is affected by false positivity due to physiologic fluorodeoxyglucose uptake in specific organ and nonspecific uptake in postoperative cases. PET with fludeoxyglucose F 18/CT is a well-established modality for diagnosis of fever of unknown origin helping in optimized management of the patient. Read More

Emerg Microbes Infect 2022 Jun 17:1-29. Epub 2022 Jun 17.

Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.

Zoonotic hepatitis E virus (HEV) is endemic in Europe. Genotype 3 (HEV-3) is predominant but information on subtype distribution, trends and clinical implications in Germany is scarce. We analysed 936 HEV RNA positive samples of human origin and corresponding national surveillance data from 2010-2019. Read More

Cureus 2022 May 12;14(5):e24949. Epub 2022 May 12.

Internal Medicine, Rochester Regional Health, Rochester, USA.

Subacute thyroiditis (SAT) is characterized by severe pain in the anterior aspect of the neck and tenderness is present during the thyroid gland's palpation. It is commonly caused by viruses including mumps, measles, rubella, coxsackievirus, influenza, and Epstein-Barr virus (EBV). Painless subacute thyroiditis is rare and can present as a fever of unknown origin (FUO). Read More

Medicine (Madr) 2022 Jun 9;13(58):3432-3437. Epub 2022 Jun 9.

Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia.

The syndromic surveillance of a group of diseases that have similar signs and symptoms, a common pathophysiology, and diverse etiology is aimed at rapidly detecting the presence of outbreaks which could potentially harm public health. This includes not only known outbreaks of infectious origin but also those of unknown origin. In patients suspected of having SARS-CoV-2/COVID-19, it is recommended to consider other etiologies of tropical fever in the differential diagnosis when these patients live in or come from endemic areas, as is the case of dengue, malaria, leptospirosis, acute Chagas disease, and rickettsiosis, among other endemic diseases. Read More

Cureus 2022 May 12;14(5):e24950. Epub 2022 May 12.

Division of Infectious Diseases, Aichi Cancer Center Hospital, Nagoya, JPN.

We report the case of a 69-year-old Japanese man who came to our hospital with a chief complaint of fever and cognitive decline for three weeks. There were no neurological abnormalities other than the decreased level of consciousness. He developed urinary retention after admission, so we performed a lumbar puncture, although his head and neck magnetic resonance imaging (MRI) showed no abnormal findings. Read More

Rev Med Interne 2022 Jun 10. Epub 2022 Jun 10.

Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude-Bernard University - Lyon 1, Lyon, France; University Claude-Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.

Introduction: Adult-onset Still's disease (AOSD) is a rare multisystemic disorder and a diagnostic challenge for physicians because of the wide range of differential diagnoses. Common features of AOSD and secondary hemophagocytic lymphohistiocytosis (sHLH) could favour diagnostic uncertainty, in particular in case of infection-related sHLH.

Observation: A 61-year-old man was admitted to our internal medicine department for suspected AOSD. Read More

Clin Nucl Med 2022 Jun 10. Epub 2022 Jun 10.

From the Departments of General Medicine.

Abstract: A 33-year-old woman presented to our hospital with a 4-month history of fever of unknown origin. Physical examination revealed a vascular murmur in the left subclavian region. Blood culture revealed bacteria and PET/CT revealed tracer accumulation in the patent ductus arteriosus area, leading to the diagnosis of infective endocarditis in this area. Read More

Case Rep Rheumatol 2022 3;2022:3671627. Epub 2022 Jun 3.

University of California, San Diego, CA, USA.

We report 3 patients who presented with abnormal pancreatic contents that were initially nondiagnostic but were eventually found to have urate crystal deposition consistent with pancreatic tophaceous gout. Our first case involved an ICU patient who had fever of unknown origin and refractory pancreatic pseudocyst. The other 2 patients presented with abdominal pain associated with a pancreatic mass which mimicked malignancy. Read More

Lancet Haematol 2022 Jun 9. Epub 2022 Jun 9.

Department of Haematology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Background: Early antibiotic discontinuation has been advocated in haematology patients with fever of unknown origin during chemotherapy-induced neutropenia, but its safety is unknown. We aimed to assess if short treatment with carbapenems is non-inferior to extended treatment.

Methods: This non-inferiority, open-label, multicentre, randomised trial was done in six hospitals in the Netherlands. Read More

Sci Rep 2022 Jun 11;12(1):9664. Epub 2022 Jun 11.

Division of Hematology, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Derech Sheba 2, 52621, Ramat Gan, Israel.

The clinical yield and benefit of performing bone marrow cultures for various clinical indications has been challenged and their clinical necessity remains debatable. We sought to assess the clinical yield and benefit of performing routine bone marrow cultures and determine whether various clinical, laboratory, and imaging parameters were predictive of a diagnostic bone marrow culture. This was a single center retrospective analysis of all patients who underwent a bone marrow study comprising bone marrow cultures from January 1, 2012, through March 1, 2018. Read More

Cardiovasc J Afr 2022 Jun 10;33:1-4. Epub 2022 Jun 10.

Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

A mycotic abdominal aortic aneurysm was detected on computed tomographic angiography of two male patients who were followed up after reporting symptoms of abdominal pain, malaise and fever of unknown origin. One of the patients' aneurysm was repaired with a tubular graft and the other patient had endovascular aneurysm repair due to his high co-morbidity. From pre-operative cultures and a pathological examination of the surgical specimens, it was observed that the aneurysms had developed in the abdominal aorta due to Salmonella enterica, and broad-spectrum antibiotic therapy was started. Read More

Am J Med 2022 Jun 4. Epub 2022 Jun 4.

Department of Internal Medicine, University of Florida College of Medicine, Jacksonville.

Monatsschr Kinderheilkd 2022 May 31:1-6. Epub 2022 May 31.

Kinderkardiologie und pädiatrische Intensivmedizin, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Deutschland.

Mol Genet Genomic Med 2022 Jun 2:e1990. Epub 2022 Jun 2.

Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Defective Cernunnos gene in nonhomologous end-joining (NHEJ) pathway of the DNA repair is responsible for radiosensitive severe combined immunodeficiency (SCID). Herein, presented a new patient with Cernunnos deficiency and summarized the clinical, immunological, and molecular features of reported patients in the literature.

Case: The patient was a 6-month-old female born to consanguineous parents. Read More

JAMA Netw Open 2022 Jun 1;5(6):e2215000. Epub 2022 Jun 1.

The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Importance: Patients meeting the criteria for fever of unknown origin (FUO) can be evaluated with structured or nonstructured approaches, but the optimal diagnostic method is unresolved.

Objective: To analyze differences in diagnostic outcomes among patients undergoing structured or nonstructured diagnostic methods applied to prospective clinical studies.

Data Sources: PubMed, Embase, Scopus, and Web of Science databases with librarian-generated query strings for FUO, PUO, fever or pyrexia of unknown origin, clinical trial, and prospective studies identified from January 1, 1997, to March 31, 2021. Read More

Nihon Ronen Igakkai Zasshi 2022 ;59(2):233-236

Department of General Internal Medicine, Kobe City Medical Center General Hospital.

Giant cell arteritis (GCA) is considered in the differential diagnosis of fever of unknown origin in the elderly. We describe the case of an 83-year-old man with GCA diagnosed by temporal artery biopsy (TBA), who did not exhibit abnormal physical and imaging findings. The patient had fever and elevated C-reactive protein (CRP), which had persisted for two months. Read More

Cureus 2022 Apr 21;14(4):e24333. Epub 2022 Apr 21.

Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.

The causes of fevers in older adults are numerous and diverse, resulting in fevers of unknown origin that complicate the diagnosis process. Compared to young adults, older adults are characterized by comorbidities, aging-induced physiological changes, decreased homeostasis, reduced activities of daily living, and a diminished quality of life due to disease and aging. Thus, diverse perspectives are required to facilitate the accurate diagnosis of fever in older adults. Read More

Semin Arthritis Rheum 2022 May 10;55:152024. Epub 2022 May 10.

Centro Malattie Autoinfiammatorie e Immunodeficienze, Clinica Pediatrica - Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy. Electronic address:

Objectives: To describe a homogeneous group of patients with undifferentiated recurrent fevers followed-up in a tertiary referral center for systemic autoinflammatory diseases (SAIDs).

Methods: Patients with undifferentiated recurrent fevers seen at our Center from 2008 to 2021 and followed-up for at least one year were included in a retrospective study. Monogenic recurrent fevers, patients carrying variants of unknown origin and PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis) syndrome were excluded. Read More

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096221101860

Medical University of South Carolina, Charleston, USA.

Infections due to nontuberculous mycobacterium (NTM) are important in chronically immunosuppressed populations and are a particular threat to solid organ transplant recipients (SOT). However, they are not a common occurrence and have protean manifestations, making it important that clinicians maintain a high degree of suspicion in the correct patient population. complex (MAC) usually presents with pulmonary involvement in immunocompetent population and disseminated disease in SOT patients with fever of unknown origin, lymphadenopathy, and cutaneous lesions being part of the well-known presentation. Read More

Clin Pathol 2022 Jan-Dec;15:2632010X221096397. Epub 2022 May 12.

The Center of Hematology and Blood Transfusion, Bach Mai Hospital, Hanoi, Vietnam.

is an obligate intracellular bacterium that causes the zoonotic infectious disease, Q fever. The common clinical presentation is fever, hepatitis, and pneumonia; laboratory examination could reveal pancytopenia, elevated liver enzymes. In bone marrow, many fibrin ring granulomas, also known as "Doughnut" granulomas can be seen and suggest the diagnosis of Q fever. Read More

Cureus 2022 Apr 16;14(4):e24192. Epub 2022 Apr 16.

Rheumatology, Akdeniz University, Antalya, TUR.

Introduction Further diagnostic procedures are necessary for patients with fever of unknown origin (FUO) and unknown cause of inflammation (inflammation of unknown origin - IUO) for the identification of the definitive diagnosis. The aim of this study was to evaluate the contribution and roles of F-18 FDG PET/CT (fluoro-18 fluorodeoxyglucose-positron emission tomography/computed tomography) in the diagnostic process of patients with FUO/IUO. Methods The data of 58 patients who had F-18 FDG PET/CT scans for FUO/IUO were re-evaluated retrospectively. Read More

Hum Vaccin Immunother 2022 May 18:2071080. Epub 2022 May 18.

Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.

Following COVID-19 vaccination, ipsilateral axillary and cervical lymphadenopathy may occur, called vaccine-related hypermetabolic lymphadenopathy, which is considered reactive lymphadenopathy. We report here a case of Kikuchi-Fujimoto disease, which occurred three months after vaccination with COVID-19 vaccine. The patient had cervical and axillary lymph node enlargement and a short-term fever that resolved spontaneously after the first and second vaccines. Read More

Eur J Intern Med 2022 Jul 14;101:108-109. Epub 2022 May 14.

Department of Internal Medicine, General Hospital of Šibenik-Knin County, Stjepana Radića 83, Šibenik 22000, Croatia; School of Medicine, University of Rijeka, Rijeka, Croatia. Electronic address:

Am J Transl Res 2022 15;14(4):2625-2636. Epub 2022 Apr 15.

Department of Hematology, Huadong Hospital, Fudan University Shanghai, China.

Background: Lymphoma has been identified as the most common cause of non-infectious fever of unknown origin (FUO). However, clinical characteristics and prognostic factors in lymphoma patients with FUO are lacking.

Methods: From January 1, 2013 to December 31, 2019, our center enrolled 185 patients who initially presented with FUO but were later diagnosed with lymphoma in Huadong Hospital of Fudan University. Read More

Cureus 2022 Apr 22;14(4):e24402. Epub 2022 Apr 22.

Anesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND.

The most common cause of postoperative fever is infection. Other causes include cancer, iatrogenic causes, venous thromboembolism, secondary to prosthetic implants, and pyrexia of unknown origin. Here, we describe five cases of opioid-induced pyrexia. Read More

Cureus 2022 Mar 21;14(3):e23368. Epub 2022 Mar 21.

Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome due to excessive immune activation leading to hyperinflammation. It may be familial due to mutations in immune regulatory genes, especially genetic defects of lymphocyte toxicity. The sporadic cases are triggered by infections (mostly viral), malignancies, and autoimmune diseases. Read More

Front Med (Lausanne) 2022 7;9:820591. Epub 2022 Apr 7.

Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Allogeneic stem cell transplantation from haplo-identical donors (haplo-HSCT) has become a well-established therapeutic option for hematological malignancies. The fever of unknown origin (haplo-fever) early after the infusion of T cell repleted graft, which returned to normal right after post-transplantation cyclophosphamide (PTCy), is a unique clinical feature in patients undergoing haplo-HSCT. In the current study, the characteristics of haplo-fever and cytokine profiles during haplo-fever were retrospectively analyzed in a cohort of 37 patients undergoing T cell repleted haplo-HSCT with PTCy as graft versus host disease (GvHD) prophylaxis. Read More