title: Clinical features of 66 lymphoma patients presenting with a fever of unknown origin.
abstract: OBJECTIVE
  To investigate the clinical characteristics, diagnostic approaches, short-term efficacy of treatment and prognosis of lymphoma patients presenting with a fever of unknown origin (FUO).
  
  
  METHODS
  We reviewed the records of 132 patients finally diagnosed with lymphoma in Huashan Hospital, half of whom initially presented with a FUO. The other 66 lymphoma patients without a history of FUO were diagnosed within a month when several patients in the FUO group were also diagnosed.
  
  
  RESULTS
  The patients presenting with a FUO were predominantly young men (71.21%, p=0.35) characterized by a temperature ≥ 39°C (55/66, 83.33%). Compared with the non-FUO group, patients in the FUO group more often had pancytopenia and hypohepatia, 61.54% with hypoalbuminemia (p<0.0001), 15.50% with significantly elevated lactate dehydrogenase (LDH) (p<0.0001), 92.45% with elevated serum β(2) microglobulin (p=0.017), 93.48% with elevated urine β(2) microglobulin (p=0.002) and 30.77% with elevated alkaline phosphatase (p=0.001). Ninety-four percent of the FUO patients had aggressive lymphomas (p=0.012), with a poor performance status (96.97%, p=0.003), stage III/IV disease (96.97%, p<0.0001), night sweats (21.21%, p=0.026), unexplained weight loss (46.97%, p=0.002) and more than one extranodal site involved (65.15%, p=0.002). The patients in the FUO group also showed poor prognoses, and most of them were in the high-intermediate or high risk classification of the disease (96.61%, p<0.0001), with a low complete remission (CR) rate (61.11% vs. 93.75%, p=0.043). Twenty-one (15.91%) of all the patients were diagnosed based on the finding of lesion sites by Positron Emission Tomography/Computed Tomography (PET/CT) scanning, which had not been detected by conventional scans.
  
  
  CONCLUSIONS
  Lymphoma presenting as FUO has a rapid progression and poor prognosis, and is difficult to diagnose. PET/CT scans can provide complementary information for an etiological diagnosis of a FUO and biopsy examinations are significant to establish an early diagnosis for patients presenting with a FUO.
authors.affiliation: Department of Hematology, Huashan Hospital, Shanghai Medical School, Fudan University, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.forename: Bobin
authors.initials: B
authors.lastname: Chen
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xu
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Lin
authors.forename: Bo
authors.initials: B
authors.lastname: Huang
authors.forename: Jing
authors.initials: J
authors.lastname: Song
authors.forename: Guowei
authors.initials: G
authors.lastname: Lin
mesh_terms: D000328:Adult; D015897:Comorbidity; D018450:Disease Progression; D004358:Drug Therapy; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008223:Lymphoma / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D001613:beta 2-Microglobulin; D007770:L-Lactate Dehydrogenase