Which symptoms suggest a noninfectious inflammatory cause of fever of unknown origin (FUO)?

Updated: Mar 01, 2018
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Collagen vascular and autoimmune diseases can manifest as FUO if the fever precedes other, more specific manifestations (eg, arthritis, pneumonitis, renal involvement). Weight loss is not unusual.

Clues and etiologic associations are as follows:

  • Headache, jaw claudication, and visual disturbances (visual loss, blurred vision, diplopia, amaurosis fugax): Giant cell or temporal arteritis
  • Symmetrical pain and stiffness of lumbar spine and large proximal muscles (neck, shoulders, hips, thighs): Polymyalgia rheumatica; also myalgias, tender muscles, lacelike rash (livedo reticularis), testicular pain
  • High-spiking fevers, nonpruritic morbilliform rash that follows the fever curve, arthralgias: Adult-onset Still disease, lymphadenopathy
  • Facial rash: SLE
  • Right lower quadrant pain, diarrhea (or none): Crohn disease (regional enteritis); Yersinia enteritis may mimic Crohn disease or appendicitis
  • Erythema nodosum, painful nodules on shins: Idiopathic erythema nodosum may itself cause fever sarcoidosis; Crohn disease; ulcerative colitis; Behçet disease

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