title: Fever of unknown origin in the 2000s: evaluation of 103 cases over eleven years.
abstract: OBJECTIVE
  Despite recent diagnostic advances, a fever of unknown origin (FUO) remains a clinical challenge.
  
  
  METHODS
  This study reports the clinical courses and outcomes of 103 cases of FUO and evaluates the places of (18)F-Fluorodeoxyglucose positrons emission tomography ((18)FDG-PET) and molecular biology in the diagnostic approach.
  
  
  RESULTS
  This retrospective study was carried out from 2002 to 2012 in two departments of internal medicine. The diagnosis of FUO was based on the updated criteria of Durack and Street. It included 54 men and 49 women (mean age: 57 years) in 52 of whom the final diagnosis could not be established. Among the 51 patients with final diagnosis, non-infectious inflammatory disorders were the most prevalent (61%). The other diagnoses were infectious diseases (23.5%), miscellaneous causes (10%) and malignancies (6%). (18)FDG-PET was performed in 48 patients and was contributory in 10. Molecular biology techniques were performed in 28 patients and were contributory in only one case: detection of a cytomegalovirus infection by polymerase-chain-reaction assay. At study closure, eleven patients had died, of whom five died from the disease that caused the FUO. Only two deaths among the 52 patients without diagnosis could be attributed to the feverish illness.
  
  
  CONCLUSIONS
  As observed in the most recent case series, the rate of undiagnosed patients is increasing. The prognosis was good for undiagnosed FUO. Here, the yield of (18)FDG-PET was 21% but that of molecular biology negligible. The recourse to molecular biology seems useless unless directed by a high degree of clinical suspicion.
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, department of internal medicine, 69004, Lyon, France; Université de Lyon, 69000 Lyon, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Robine
authors.affiliation: Université de Lyon, 69000 Lyon, France; Hospices civils de Lyon, hôpital Edouard-Herriot, department of internal medicine, 69003 Lyon, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Hot
authors.affiliation: Université de Lyon, 69000 Lyon, France; Hospices civils de Lyon, hôpital Lyon-Sud, department of biostatistics, 69310 Pierre-Bénite, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Hospices civils de Lyon, hôpital Lyon-Sud, department of biostatistics, 69310 Pierre-Bénite, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Iwaz
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, department of internal medicine, 69004, Lyon, France; Université de Lyon, 69000 Lyon, France.
authors.forename: Christiane
authors.initials: C
authors.lastname: Broussolle
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, department of internal medicine, 69004, Lyon, France; Université de Lyon, 69000 Lyon, France. Electronic address: pascal.seve@chu-lyon.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sève
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004269:DNA, Bacterial / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005293:Ferritins / Q000097:blood; D005335:Fever of Unknown Origin / Q000209:etiology*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007239:Infections / Q000150:complications / Q000175:diagnosis; D007249:Inflammation / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis; D016133:Polymerase Chain Reaction; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D004279:DNA, Viral; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005293:Ferritins