Background Fever of unknown origin (FUO) remains one of the major diagnostic challenges for the clinician. Although infection, malignancy and collagen vascular disease are accepted the 3 most important causes of FUO, the relative importance of these major categories might have changed because of improvements in serodiagnosis, culture techniques and radiologic imaging modalities. Rheumatic diseases not uncommonly present with fever.
Objectives Our objective was to make an uptake of our knowledge regarding causes of FUO in our hospital together with more detailed analysis of collagen vascular and granulomatous disorders presenting with FUO.
Methods In this clinical investigation, we retrospectively evaluated hospital records of patients who were hospitalised in our Infectious Diseases Service from January 1990 through September 2000 to investigate the cause of prolonged fever. One hundred forty-five patients (63 female, 82 male, mean age: 38.5, min-max: 16–80) meeting the classical criteria of FUO were included in the present study.
Results Infections, rheumatic diseases and malign disorders were found in 93 (64.1%), 24 (16.6%) and 8 patients (5.5%), respectively. Infectious causes are the most common cause in all age groups, and rheumatic disease are the second. Malign diseases were diagnosed in 2.7% of patients under age 50, and percentage of these disorders increased to 15.6% among patients over 50. Miscellaneous conditions were found in 2 patients (1.4%), and despite detailed evaluation 18 patients (12.4%) remained undiagnosed. List of rheumatic diseases diagnosed as causes of FUO in the present study are given in Table 1.
Conclusion In conclusion, despite widespread use of antibiotics and increasingly useful diagnostic technologies, infectious disease still remain the leading cause of FUO among our group of patients, and collagen vascular diseases together with granulomatous disorders are the second most common group. The percentage of tumours was higher in our elderly patients than in the younger ones but still clearly lower than other causes of FUO in adults. Infectious Diseases Department of Hacettepe University is one of the reference centres in Turkey, and many undiagnosed cases are being referred to our hospital. Therefore we believe that, although we performed the present study only from our hospital reports, the results may reflect the general population of central Anatolia.
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