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Case Rep Rheumatol 2021 13;2021:6629405. Epub 2021 Apr 13.

Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Diagnosing infantile Kawasaki disease with atypical symptoms is difficult, and it also has higher risk of coronary abnormalities which is one of the most common complications of KD. Other complications such as pericardial effusion, mitral insufficiency, congestive heart failure, myocardial systolic dysfunction, and systemic vasculitis were also reported. Peripheral gangrene and necrosis are among the rare complications of this systemic vasculitis. Read More

Clin Case Rep 2021 Apr 8;9(4):2350-2355. Epub 2021 Mar 8.

Department of Clinical Pharmacy and Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences Isfahan University of Medical Sciences Isfahan Iran.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening clinical syndrome, which may present with FUO. The possible diagnosis of HLH must be considered in the differential diagnosis when a patient presents with FUO. Read More

Clin Case Rep 2021 Apr 4;9(4):2323-2327. Epub 2021 Mar 4.

Paediatric Neurology Service Department of Paediatric Medicine KK Women's and Children's Hospital Singapore City Singapore.

Fever of unknown origin (FUO) is a diagnostic challenge. Anti-N-methyl-D-aspartate receptor encephalitis should be considered in children with FUO and new-onset neurological symptoms without significant encephalopathy. Read More

Cancers (Basel) 2021 Apr 21;13(9). Epub 2021 Apr 21.

Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, 48149 Münster, Germany.

The purpose of this retrospective, single-center cohort study was to assess the infectious burden in pediatric sarcoma patients during neoadjuvant chemotherapy. The review included all patients with a new diagnosis of Ewing sarcoma, osteosarcoma or soft tissue sarcoma between September 2009 and December 2018 who were enrolled in the EWING 2008, CWS SoTiSaR and EURAMOS clinical trial or registry. Primary endpoints were the occurrence of febrile neutropenia (FN) and microbiologically documented infection (MDI). Read More

J Clin Med 2021 Apr 6;10(7). Epub 2021 Apr 6.

Service de Médecine Interne et Immunologie Clinique, APHP, Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, 94720 Le Kremlin-Bicêtre, France.

Splenectomy is indicated in cases of trauma to the spleen or hematological and immunological diseases (hereditary spherocytosis, autoimmune cytopenia). Less frequently, splenectomy is performed for diagnostic purposes to complement unsuccessful prior etiological investigations. The splenectomy remains a surgery at risk of complications and should be considered as a last-resort procedure to make the diagnosis and to be able to treat patients. Read More

Adv Biomed Res 2020 23;9:75. Epub 2020 Dec 23.

Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Extrapulmonary tuberculosis (TB) is a well-recognized cause of pyrexia of unknown origin. However, clinical presentation of TB in children with isolated hematological abnormalities is extremely rare. Anemia, usually normocytic, normochromic, leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, and monocytosis are more common complications of TB rather than pancytopenia. Read More

IDCases 2021 1;24:e01099. Epub 2021 Apr 1.

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.

Am J Case Rep 2021 Apr 27;22:e930286. Epub 2021 Apr 27.

Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka City, Fukuoka, Japan.

BACKGROUND Pembrolizumab is a humanized monoclonal antibody against programmed cell death-1 protein. Pembrolizumab sometimes causes immune-related adverse events (irAEs). Dermatomyositis is a rare irAE of immune checkpoint inhibitors. Read More

Minerva Endocrinol (Torino) 2021 Apr 21. Epub 2021 Apr 21.

Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Medicine (Baltimore) 2021 Apr;100(16):e25538

Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

Abstract: There are over 200 causes of fever of unknown origin (FUO), and although parasitic infection is an increasingly uncommon cause, a definitive diagnosis remains important to ensure rapid treatment and to prevent adverse sequelae through delay. Here, we studied the clinical features and outcomes of patients admitted with FUO and diagnosed with parasitic infection to improve our understanding of the features of parasitic FUO.Medical records of patients admitted to Peking Union Medical College Hospital between 2013 and 2019 with FUO and diagnosed with parasitic infection were reviewed. Read More

PLoS Negl Trop Dis 2021 Apr 19;15(4):e0009355. Epub 2021 Apr 19.

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

Background: Current knowledge on Rickettsia felis infection in humans is based on sporadic case reports. Here we conducted a retrospective seroepidemiological survey of R. felis infection among febrile patients visiting a medical center in Taipei. Read More

Rev Med Suisse 2021 Apr;17(734):738-743

Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14.

Despite the diagnostic means currently available, fever of unknown origin (FUO) remains a diagnostic challenge for the practitioner, requiring a detailed and systematic approach. The etiologies can be classified into 4 main groups: infectious diseases, systemic inflammatory diseases, neoplasia and various rarer entities such as drug-induced or endocrine fevers. A non-negligible percentage of FUOs remains without a clear etiology, generally with a spontaneously favorable evolution. Read More

Intern Med 2021 Apr 12. Epub 2021 Apr 12.

Department of Respiratory Medicine, Saitama Red Cross Hospital, Japan.

A 94-year-old woman with rheumatoid arthritis who had been treated with low-dose methotrexate was referred to our hospital because of a 3-day history of a fever and pancytopenia. With a diagnosis of febrile neutropenia of unknown origin, empirical antibiotic treatment and folinic acid therapy were initiated. Despite a recovery from pancytopenia, the high fever remained, and dyspnea developed. Read More

Rev Argent Microbiol 2021 Apr 7. Epub 2021 Apr 7.

Laboratorio Central, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.

Human parechovirus (HPeV) is one of the members of the family Picornaviridae that has been associated with fever of unknown origin, gastroenteritis, clinical sepsis, meningitis, or encephalitis in very young infants. HPeV detection is not routinely performed in most clinical microbiology laboratories in Argentina and, therefore, its real prevalence is unknown. We here report three cases of HPeV CNS infection that presented to our hospital with different clinical features after the implementation of a multiplex PCR meningitis/encephalitis panel. Read More

Int J Antimicrob Agents 2021 Apr 7:106335. Epub 2021 Apr 7.

Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.

Objectives: We evaluate ceftazidime/avibactam (C/A) and ceftolozane/tazobactam (C/T) use in hematological patients with febrile neutropenia (FN) receiving high-dose chemotherapy and HSCT.

Methods: Between January-December 2018, we conducted a retrospective study to assess C/A and C/T efficacy through infection-related mortality (IRM) and bacteremia clearance for carbapenem-resistant Gram-negative bacteria (CR-GNB) pre-engraftment blood-stream infections (PE-BSIs).

Results: Seventy patients underwent allogeneic HSCT: C/A and C/T were dispensed in 13% and 3%, respectively. Read More

Am J Emerg Med 2021 Apr 2;48:1-11. Epub 2021 Apr 2.

Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.

Purpose: Patients evaluated in the emergency department (ED) who have concerning symptoms suggestive of a cancer diagnosis are mostly referred to the quick diagnosis unit of our tertiary hospital. This study analyzed the impact of the Covid-19 pandemic on the volume, disease patterns, and accessibility to essential investigations of patients with suspected cancer referred by the ED to this unit.

Methods: Trends in referrals were analyzed from January 1 to July 8, 2020 and the corresponding dates of 2019. Read More

Memo 2021 Apr 1:1-5. Epub 2021 Apr 1.

Department of Hematology and Oncology, Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.

HLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. Read More

Jpn J Clin Oncol 2021 Apr 5. Epub 2021 Apr 5.

Department of Nuclear Medicine, Affiliated Hospital of Guangdong Medical University, ZhanJiang, People's Republic of China.

Int J Environ Res Public Health 2021 03 20;18(6). Epub 2021 Mar 20.

Department of Industrial Engineering, University of Rome "Tor Vergata", 00133 Rome, Italy.

Background: Several technologies for rapid molecular identification of pathogens are currently available; jointly with monitoring tools (i.e., web-based surveillance tools, infectious diseases modelers, and epidemic intelligence methods), they represent important components for timely outbreak detection and identification of the involved pathogen. Read More

Sci Rep 2021 Apr 1;11(1):7385. Epub 2021 Apr 1.

Florida International University, Miami, FL, USA.

The aim of this study was to estimate the trends and burdens associated with systemic therapy-related hospitalizations, using nationally representative data. National Inpatient Sample data from 2005 to 2016 was used to identify systemic therapy-related complications using ICD-9 and ICD-10 external causes-of-injury codes. The primary outcome was hospitalization rates, while secondary outcomes were cost and in-hospital mortality. Read More

Ecancermedicalscience 2021 9;15:1182. Epub 2021 Feb 9.

Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore.

The differential diagnosis of ring-enhancing brain lesions in a patient with metastatic malignancy may initially seem straightforward, and easily attributed to brain metastases. On rare occasions, the physician needs to avoid anchoring bias by re-evaluating the entire clinical context in which these ring-enhancing brain lesions are found. We report a case of cerebral toxoplasmosis mimicking brain metastases in a patient with metastatic cancer and without a prior history of human immunodeficiency virus. Read More

Am J Case Rep 2021 Mar 27;22:e930559. Epub 2021 Mar 27.

Department of Endocrinology and Diabetes Mellitus, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom.

BACKGROUND Dialister pneumosintes is a suspected periodontal pathogen. It can affect different parts of the body either by hematogenous transmission or regional spread. Here, we report a case of 30-year-old previously healthy woman diagnosed with mediastinal and neck abscess caused by this pathogen. Read More

BMJ Case Rep 2021 Mar 26;14(3). Epub 2021 Mar 26.

Rheumatology, Parkview Medical Center, Pueblo, Colorado, USA.

Fever of unknown origin (FUO) has a broad differential diagnosis, including infectious, inflammatory and malignant aetiologies. Granulomatosis with polyangiitis (GPA) can present with non-specific symptoms, including fever, lethargy and flu-like illness. While systemic vasculitis causing FUO has been well-documented, GPA as an underlying cause for FUO poses a diagnostic and therapeutic challenge for clinicians. Read More

J Card Surg 2021 Jun 25;36(6):2175-2178. Epub 2021 Mar 25.

Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Transient fever is not uncommon postcardiac surgery, usually related to underlying clinical process such as inflammation related to the physiological insult or infection. Here, we present a case series of two patients who underwent repair for type A aortic dissection with Gelweave graft prosthesis who had persistent fevers, leukocytosis, and raised inflammatory markers persisting months after surgery. Both patients were found to have sterile perigraft fluid collections. Read More

Eur J Case Rep Intern Med 2021 9;8(3):002254. Epub 2021 Feb 9.

Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.

Giant cell arteritis (GCA), or Horton's arteritis, presenting solely as fever is very rare. Usually, it manifests with typical features such as visual problems, headache and jaw claudication, or it can be associated with polymyalgia rheumatica. We describe the case of a patient with GCA who presented only with prolonged fever, the cause of which was not determined by diagnostic tests. Read More

Medicine (Baltimore) 2021 Mar;100(12):e25259

Division of General Medicine, Showa University Koto Toyosu Hospital, Tokyo.

Rationale: Although single organ vasculitis (SOV) is a rare occurrence and it is difficult to diagnose, its possibility as a cause of fever of unknown origin (FUO) must be considered. Recently, the usefulness of 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) in the diagnosis of unknown fevers due to vasculitis, especially in cases of small and medium-sized vasculitis, has begun to be pointed out.

Patient Concerns: We report the case of an 84-year-old woman with persisting fever for more than 2 weeks. Read More

Eur J Paediatr Neurol 2021 Mar 11;32:1-7. Epub 2021 Mar 11.

Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA. Electronic address:

Background: Many central nervous system disorders result in hypothalamic-pituitary (HP) axis dysfunction. Alternating Hemiplegia of Childhood (AHC) is usually caused by mutations in the ATP1A3 subunit of the Na/K ATPase, predominantly affecting GABAergic interneurons. GABAergic interneurons and the ATP1A3 subunit are both important for function of the hypothalamus. Read More

Vnitr Lek 2021 ;67(1):32-42

Fever of unknown origin is a rare clinical syndrome, that represents a significant diagnostic challenge. There have been described more than 200 potential diseases, that can manifest as a fever of unknown origin. These are classically divided into following categories: infections, non-infectious inflammatory diseases, malignancies, and other miscellaneous disorders. Read More

Cureus 2021 Feb 14;13(2):e13338. Epub 2021 Feb 14.

Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND.

Schnitzler syndrome (SS) is a rare disease of unknown etiology. Literature suggests that only around 300 well-diagnosed cases have only been reported worldwide and rarely from India. This syndrome has a slight male predominance with a mean age of onset of around 50 years. Read More

Monatsschr Kinderheilkd 2021 Mar 11:1-8. Epub 2021 Mar 11.

Schwachhauser Heerstr. 163a, 28211 Bremen, Deutschland.

Fever of unknown origin is diagnosed when the fever (mostly defined as an elevated body temperature ≥38.3 °C measured by rectal or tympanic route) lasts longer than expected, i.e. Read More