Yield of bone marrow examination in diagnosing the source of fever of unknown origin.
BACKGROUND
Fever of unknown origin (FUO) still remains a diagnostic challenge, while diagnosis may remain obscure for several weeks or months. The role of tissue biopsy is crucial in the diagnostic approach. We report a series of 130 consecutive patients with FUO who had undergone a bone marrow biopsy (BMB).


METHODS
Among 280 consecutive nonimmunocompromised patients hospitalized between 1995 and 2005 for a febrile illness of uncertain cause, lasting at least 3 weeks, with no diagnosis after an appropriate minimal diagnostic workup, 130 underwent BMB.


RESULTS
Overall, a specific diagnosis was achieved by BMB and histological examination in 31 cases (diagnostic yield, 23.7%). Three types of diseases were found: hematological malignant diseases in 25 cases, including 19 patients with malignant lymphoma, 4 with acute leukemia, 1 with hairy cell leukemia, and 1 with multiple myeloma; infectious diseases in 3 cases; systemic mastocytosis in 2 cases; and disseminated granulomatosis in 1 case. Thrombocytopenia (odds ratio, 4.9; 95% confidence interval, 1.04-9.30) and anemia (odds ratio, 3.24; 95% CI, 1.13-9.34) were the most reliable predictive factors regarding the usefulness of BMB. Bone marrow cultures had very limited value in our cohort. Finally, corticosteroid use did not seem to affect the yield of BMB.


CONCLUSIONS
Bone marrow biopsy is a useful technique for the diagnosis of prolonged fever in immunocompetent patients. Thrombocytopenia and anemia seem to be correlated with the value of this test.
Hot
Arnaud
A
Service de Médecine Interne, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437 Lyon CEDEX 03, France. arnaud.hot@wanadoo.fr.
Jaisson
Isabelle
I
Girard
Charlotte
C
French
Martine
M
Durand
Denis Vital
DV
Rousset
Hugues
H
Ninet
Jacques
J
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001853:Bone Marrow / Q000187:drug effects; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D007239:Infections / Q000175:diagnosis; D007249:Inflammation / Q000175:diagnosis; D007938:Leukemia / Q000175:diagnosis; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
D000305:Adrenal Cortex Hormones