title: Diagnostic splenectomy in patients with fever of unknown origin and splenomegaly.
abstract: OBJECTIVE
  To review the diagnostic significance, safety and possible risk factors of splenectomy in fever of unknown origin (FUO) with splenomegaly.
  
  
  METHODS
  The records of 54 patients with FUO and splenomegaly who underwent splenectomy in our hospital in the past 20 years were reviewed retrospectively. Pathologic findings, morbidity, mortality and possible risk factors were analyzed.
  
  
  RESULTS
  Histologic findings included 29 cases of non-Hodgkin lymphoma, 4 cases of spleen tuberculosis, 3 cases of Hodgkin lymphoma, 1 case of Castleman disease and 2 cases of hemophagocytic syndrome. An etiologic diagnosis was made in 72.2% of the patients undergoing splenectomy. Surgical complications occurred in 25.9% of the patients and 1-month operative mortality was 16.7%. The mortality rate 1 month after surgery was significantly associated with serous cavity effusion (46.2 vs. 7.5%, p = 0.006) and spleen weight >1,500 g (50.0 vs. 9.1%, p = 0.007). There was no significant difference in the mortality rate of the patients with or without jaundice, pancytopenia, elevated serum alanine aminotransferase (ALT) or elevated LDH (p > 0.5). Multivariate analysis revealed serous cavity effusion (odds ratio 21.0; 95% confidence interval 2.2-212.8; p = 0.01) and spleen weight >1,500 g (odds ratio 18.0; 95% confidence interval 1.9-173.8; p = 0.01) as independent risk factors.
  
  
  CONCLUSIONS
  Splenectomy is an effective diagnostic modality for FUO presenting with splenomegaly. The presence of serous cavity effusions and spleen weight >1,500 g identifies patients with the greatest operative risk.
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Han
authors.forename: Zhiying
authors.initials: Z
authors.lastname: Yang
authors.forename: Ti
authors.initials: T
authors.lastname: Yang
authors.forename: Weisheng
authors.initials: W
authors.lastname: Gao
authors.forename: Xinting
authors.initials: X
authors.lastname: Sang
authors.forename: Yongqiang
authors.initials: Y
authors.lastname: Zhao
authors.forename: Ti
authors.initials: T
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005335:Fever of Unknown Origin / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008223:Lymphoma / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy; D013163:Splenomegaly / Q000150:complications*; D015996:Survival Rate