Which physical findings suggest specific causes 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

Physical examination clues to causes of FUO are as follows:

  • Pulse-temperature deficit or relative bradycardia (inappropriately low pulse rate for degree of fever, in the absence of beta blockade): Typhoid fever, Q fever, psittacosis, legionellosis, lymphoma, drug fever
  • Unequal pulse in upper extremities: Takayasu arteritis
  • Eyes - Roth spots, retinal artery occlusion: SLE, vasculitis, bacterial endocarditis, cat scratch disease (stellate retinitis)
  • Oral ulcers: SLE, Behçet disease, histoplasmosis
  • Tender tooth on percussion, caries/gingivitis: Dental abscess
  • Enlarged or tender thyroid: Thyroiditis
  • Lymphadenopathy: Sarcoidosis, SLE, adult-onset Still disease, granulomatous infections, hematologic malignancies
  • Cardiac murmur: SLE (Libman-Sacks endocarditis), bacterial endocarditis
  • Hepatomegaly without splenomegaly: Granulomatous hepatitis, primary liver cancer, renal cell carcinoma, or liver metastases; excludes collagen vascular disease and hematologic malignancy
  • Splenomegaly without hepatomegaly: Bacterial endocarditis, EBV/CMV infection, typhoid, tuberculosis, histoplasmosis, brucellosis, malaria, Q fever, borreliosis (relapsing fevers), cirrhosis
  • Tenderness to palpation of sternum: Hematologic malignancy
  • Tenderness to percussion over a vertebra: Vertebral osteomyelitis, tuberculosis, typhoid, brucellosis
  • Epididymitis or nodules: Sarcoid, SLE, polyarteritis nodosa
  • Tender red nodules on shins: Idiopathic erythema nodosum (EN), collagen vascular disease, granulomatous infections, EBV infection, typhoid, bartonellosis, drug fever

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