Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.
Heart Lung. 2010 Jan-Feb;39(1):73-7. doi: 10.1016/j.hrtlng.2009.06.006. Epub 2009 Sep 3.
Fever of unknown origin (FUO) refers to prolonged fevers of > or = 101 degrees F and that persists for > 3 weeks that remain undiagnosed after an intensive in-hospital/outpatient workup. The most common FUO categories of are infectious, neoplastic, rheumatic/inflammatory, and miscellaneous causes. Malignancies have supplanted infectious diseases as the most common cause of FUOs in the adult population. Rheumatic/inflammatory causes of FUO are relatively less common than previously because of the introduction over the years of sophisticated diagnostic tests for most rheumatic diseases. The rheumatic/inflammatory disorders that remain important causes of FUO today are those that cannot be readily diagnosed by readily available/noninvasive tests, for example, adult Still's disease and temporal arteritis (TA). In older patients with FUO, TA can be a difficult diagnosis when the characteristic findings (ie, scalp tenderness, jaw claudication) are not present. Patients with TA presenting as FUO often have only headaches that may be accompanied by bilateral jaw discomfort. Endocrine causes of FUOs are rare. The most common endocrine disorder rarely presenting as an FUO is de Quervain's subacute thyroiditis. As in TA, subacute thyroiditis may present with headache and pain at the angle of the jaw. Both TA and subacute thyroiditis may be accompanied by fatigue, weight loss, and night sweats. We present a case of 55-year-old woman who presented with an FUO with clinical and laboratory findings suggesting TA. However, the absence of thrombocytosis and a normal alkaline phosphatase argued against the diagnosis of TA. Also against the diagnosis of TA was weight loss without loss of appetite and a slightly increased pulse. After nonspecific laboratory test results suggested that TA was not the cause of her FUO, additional tests were ordered. Thyroid function test results suggested the possibility of de Quervain's subacute thyroiditis as the cause of her FUO. To the best of our knowledge, this is the first case of de Quervain's subacute thyroiditis presenting as an FUO with elevated ferritin levels.
不明原因发热（FUO）是指体温持续超过 101 华氏度（约 38.3 摄氏度）并持续超过 3 周，经过强化住院/门诊检查后仍无法明确诊断。FUO 最常见的类别是感染性、肿瘤性、风湿性/炎症性和其他原因。恶性肿瘤已取代传染病成为成人 FUO 最常见的原因。由于多年来对大多数风湿性疾病都引入了复杂的诊断测试，因此 FUO 中风湿性/炎症性原因相对较少见。今天仍然是 FUO 重要原因的风湿性/炎症性疾病是那些无法通过现成的/非侵入性测试轻易诊断的疾病，例如成人斯蒂尔病和颞动脉炎（TA）。在 FUO 的老年患者中，如果没有典型的发现（即头皮触痛、下颌运动障碍），TA 可能难以诊断。表现为 FUO 的 TA 患者通常只有头痛，可能伴有双侧下颌不适。内分泌性 FUO 较为罕见。很少表现为 FUO 的最常见内分泌疾病是 De Quervain 亚急性甲状腺炎。与 TA 一样，亚急性甲状腺炎可能表现为头痛和下颌角疼痛。TA 和亚急性甲状腺炎都可能伴有疲劳、体重减轻和盗汗。我们报告了一例 55 岁女性，她因 FUO 就诊，临床和实验室检查结果提示 TA。然而，血小板增多症和碱性磷酸酶正常排除了 TA 的诊断。也不支持 TA 诊断的是无食欲减退的体重减轻和脉搏略增加。非特异性实验室检查结果提示 TA 不是她 FUO 的原因后，又进行了其他检查。甲状腺功能检查结果提示可能是 De Quervain 亚急性甲状腺炎引起了她的 FUO。据我们所知，这是首例表现为 FUO 和铁蛋白水平升高的 De Quervain 亚急性甲状腺炎。
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