1/11. High fever. Experience in private practice.Experience with confirmed high fever, 40 C (104 F) or more, in a private practice during 14 years is presented. The records of 1,500 patients covering 8,000 patient years disclosed only 108 confirmed episodes of high fever. Eleven diagnostic categories included 149 diagnoses. Fourteen of 43 roentgenographic examinations yielded positive findings, including two cases of pneumonia not detected on physical examination. Two of six stool cultures yielded specific enteric pathogens. Convulsions occurred in 12 of the 108 episodes of high fever, and recurred only once in one child. There were no deaths in this series of children with high fevers. Only one diagnosis, pneumonia, was significantly more frequent in confirmed high fever than in unconfirmed high fever. Lastly, the ability of a group of mothers to read thermometers set at three different temperatures proved to be surprisingly good.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/11. Long-lasting fever of unknown origin preceding the diagnosis of intravascular lymphomatosis: a further case stimulates some remarks.Neurological and skin involvements usually dominate the clinical presentation of intravascular lymphomatosis (IL), while fever is the most frequent general sign. However, an onset only characterized by fever of unknown origin (FUO) has been rarely reported. We would like to describe a further case of IL, which presented a long-lasting FUO before the diagnosis. At admission, physical examination detected hepatosplenomegaly without lymph nodes enlargement or dermatological or neurological abnormalities. Significant laboratory data included severe anemia, leukopenia, thrombocytopenia, and increased serum LDH. Moreover, a chest CT evidenced bilateral multiple pulmonary infiltrates and pleural effusion. After the development of proteinuria, a diagnosis of large B-cell intravascular lymphoma was made with a renal biopsy 10 months after the onset of the clinical manifestations. So far, more than 100 cases of IL have been reported and the diagnosis often turned out to be difficult, as clinical signs did not point to a lymphoproliferative disorder. This report confirms that FUO is not only frequently associated with IL but that it even marks the real onset of the disease. We are then tempted to conclude that undiagnosed fever is not so rare in IL and if we call it FUO, it is only because diagnosis is necessarily elusive and hence time-consuming.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/11. fever of unknown origin.This is a case study of a 26-year-old Hispanic male who presented with an initial complaint of fevers, chills and generalized weakness for three weeks. Patient reported a classical history of diurnal fever with temperature spikes as high as 105.8F after returning from a trip to guatemala. His symptoms had waxed and waned for 3 weeks. This case study will focus on the initial presentation, value of complete history and physical exam, use of laboratory data and use of specialized diagnostic procedures in the outpatient setting. This case proves to be highly relevant to primary care in the context of treating patients with fevers of unknown etiology. Primary care physicians should be alert for unusual diseases in patients who are returning from foreign travel. malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of plasmodium organisms on a specially prepared blood film. This case study speaks to the importance of prompt work up and treatment of fever of unknown origin that presents in an unusual clinical picture or that is not readily explainable.- - - - - - - - - - ranking = 0.050222691441945keywords = physical (Clic here for more details about this article) |
4/11. Intrahepatic cholangiocarcinoma masked as fever of unknown origin.Intrahepatic cholangiocarcinoma is a rare malignancy that often presents in an advanced stage. For many patients, early diagnosis is often delayed, secondary to vague symptoms and a lack of physical findings. Herein, we report an unusual case of fever of unknown origin secondary to intrahepatic cholangiocarcinoma.- - - - - - - - - - ranking = 0.050222691441945keywords = physical (Clic here for more details about this article) |
5/11. fever of unknown origin in carcinoma of the colon.OBJECTIVE: To report a case of fever of unknown origin in a patient with carcinoma of the colon but without gastrointestinal symptoms. CLINICAL PRESENTATION AND INTERVENTION: A 65-year-old man presented with a long-standing fever (of 38 degrees C, about two months' duration), night sweats, fatigue, malaise and anxiety. General physical examination including rectum, radiographic examinations of the chest, abdomen and bones (including ultrasonography and CT scanning) was normal. biochemistry profile as well as other laboratory studies including blood, urine and stool cultures were normal except for erythrocyte sedimentation rate, which was 105 mm/h. A barium enema showed a rectosigmoid carcinoma. A left sigmoidal colectomy was performed. The patient recovered quickly and remained well for eight years postoperatively. CONCLUSION: This case shows that carcinoma of the colon should be included in the differential diagnosis of patients with fever of unknown origin.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/11. Reverse Shapiro's syndrome--an unusual cause of fever of unknown origin.Reverse Shapiro's syndrome was first described by Hirayama et al. in a girl with periodic hyperthermia associated with complete agenesis of the corpus callosum. Here we report another such case in a 9-month-old girl presenting with fever of unknown origin since the age of 7 months. On examination, she had mild hypotonia with delayed developmental milestones. No other neurological or physical abnormalities were noted. The cause of her prolonged fever of unknown origin was investigated and all results were negative. Her brain magnetic resonance images showed agenesis of the corpus callosum. On the basis of the previous literature, we suggest that the periodic hyperthermia of this girl was caused by dopaminergic denervation of the hypothalamic thermoregulatory center. Treatment with dopamine agonists (levodopa plus carbidopa) failed to control the hyperthermia.- - - - - - - - - - ranking = 0.050222691441945keywords = physical (Clic here for more details about this article) |
7/11. Evaluating postoperative fever: a focused approach.Postoperative fever should be evaluated with a focused approach rather than in "shotgun" fashion. Most fevers that develop within the first 48 hours after surgery are benign and self-limiting. However, it is critical that physicians who provide postoperative care be able to recognize the minority of fevers that demand immediate attention, based on the patient's history, a targeted physical examination, and further studies if appropriate. Fever that develops after the first 2 days following surgery is more likely to have an infectious cause, but noninfectious causes that require further evaluation and treatment must also be considered. When evaluating postoperative fever, a helpful mnemonic is the "four Ws": wind (pulmonary causes: pneumonia, aspiration, and pulmonary embolism, but not atelectasis), water (urinary tract infection), wound (surgical site infection), "what did we do?" (iatrogenic causes: drug fever, blood product reaction, infections related to intravenous lines).- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/11. fever of unknown origin following traumatic brain injury.Fever is a common complication of a traumatic brain injury, occurring during both the acute-care phase and the rehabilitation phase of recovery. The aetiology of fever in this population may remain obscure because of the presence of cognitive confusion associated with post-traumatic amnesia interfering with history taking and the difficult physical examination. We present a case where recovery from a traumatic brain injury was complicated by a fever of unknown origin that proved to be secondary to lateral sinus thrombophlebitis. This case emphasises the importance of a thorough knowledge of the differential diagnosis for fever that is unique to the traumatic brain injury population.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/11. Polyarteritis manifesting as calf myositis and fever.A patient presented with fever of undetermined cause for two months. On physical examination, bilateral calf tenderness was elicited, prompting a diagnostic muscle biopsy for polyarteritis. This limited form of polyarteritis is reviewed in the context of this case and previously reported cases. Polyarteritis limited to muscle seems to have a good prognosis and responds readily to steroids alone.- - - - - - - - - - ranking = 0.050222691441945keywords = physical (Clic here for more details about this article) |
10/11. Multiple Beau's lines in a patient with fever of unknown origin.We describe a case of fever of unknown origin (FUO) of 9 months' duration in which the finding of regularly spaced multiple Beau's lines (the "ladder nail" sign) pointed to the possibility of a relapsing fever of the Pel-Ebstein variety and an underlying lymphoma. Subsequent investigation confirmed the association of the Beau's lines and fever, as well as the diagnosis of Hodgkin's disease as the cause of the FUO. In this setting, Beau's lines may provide an important diagnostic clue and should be carefully looked for on physical examination.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
| | Next -> |