Fever of unknown origin—investigation and management

Abstract 

Fever of unknown origin is defined as fever with documented temperatures of >38.3°C on several occasions, persisting for more than 3 weeks, and uncertain diagnosis after intensive study for at least a week. Over 200 causes are described. The commonest are infections, collagen vascular disease and malignancy. The key to diagnosis is a complete history, which should be repeated if no diagnostic clues emerge from the initial assessment, and a careful physical examination. A limited number of baseline investigations should be performed. Thereafter, further investigations should be determined by diagnostic clues gleaned from the above. Apart from chest X-ray and abdominal ultrasound, imaging should not be performed routinely. The role of nuclear medicine techniques remains unclear. In children with recurrent fever, periodic fever syndromes should be considered. Although the diagnosis remains obscure in most FUOs, the prognosis for children who remain undiagnosed is good. The temptation to over-investigate should therefore be resisted.

Keywords: fever of unknown origin, periodic fever, history taking, nuclear imaging

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