title: Multiple myeloma presenting as fever of unknown origin.
abstract: BACKGROUND: Multiple myeloma (MM) itself is not considered to be responsible for fever and is not usually listed among the causes of fever of unknown origin (FUO). METHODS: We report three cases of MM presenting with specific fever that we analyze in combination with the three previously published cases. RESULTS: MM could easily be suspected in most, but not all, cases, emphasizing that bone marrow aspiration should be a part of 'standard' FUO investigations. All patients underwent extensive, sometimes potentially harmful, investigations. Conventional treatment of MM produced a sustained improvement in the temperature curve and inflammatory syndrome in all cases within a few months. Fever recurred during nearly all relapses. Six patients died, one after a disease course of more than 8 years. CONCLUSIONS: This series shows that MM may present as a FUO and that useless and hazardous investigations may be avoided given the possibility of specific fever in this disease. Chemotherapy must be considered without much delay after a reasonable work-up to eliminate any associated process, especially infections.
authors.affiliation: Immuno-Hematology Unit, Department of Clinical Immunology, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75475 Cedex 10, Paris, France
authors.forename: Olivier
authors.initials: O
authors.lastname: Lambotte
authors.forename: Bruno
authors.initials: B
authors.lastname: Royer
authors.forename: Philippe
authors.initials: P
authors.lastname: Genet
authors.forename: Pauline
authors.initials: P
authors.lastname: Brice
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Brouet
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Fermand