[Clinical thinking and decision making in the practice. A patient with fever of unknown origin].
A 75-year-old woman was admitted because of fever of unknown origin (FUO). In the year before the current admission she developed myalgias and was treated for polymyalgia rheumatica with low-dose prednisone. Her complaints persisted and prednisone was discontinued. Five months before the present admission she developed fever (37.7-38.9 degrees C), malaise, fatigue and occipital headache. Laboratory tests showed an elevated erythrocyte sedimentation rate (98 mm in the first hour) and a severe hypochromic, slightly microcytic, anaemia. Although a recent temporal artery biopsy was negative, a second biopsy was taken which showed giant cell arteritis. The patient was treated with high-dose prednisone (60 mg daily) and made a full recovery. It is emphasized that temporal arteritis is a common cause of FUO in the elderly.
Schippers
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EF
Leids Universitair Medisch Centrum, afd. Algemene Interne Geneeskunde, Leiden.
de Meijer
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PH
Meinders
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AE
D000368:Aged; D000747:Anemia, Hypochromic / Q000150:complications / Q000175:diagnosis; D001706:Biopsy; D001799:Blood Sedimentation; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D013700:Giant Cell Arteritis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D011111:Polymyalgia Rheumatica / Q000175:diagnosis / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use
D011241:Prednisone
Klinisch denken en beslissen in de praktijk. Een patiënte met febris e causa ignota.