Puchi Silva Alexa, López Radrigán Paulina, Zapico Lafuente Montserrat, Tapia Carrere Sergio, González Bombardiere Sergio
Escuela de Medicina, Facultad de Medicina, Universidad Andres Bello, Viña del Mar, Chile.
Universidad Andres Bello, Viña del Mar, Chile.
Rev Chil Pediatr. 2017 Jun;88(3):398-403. doi: 10.4067/S0370-41062017000300014.
Fever of unknown origin (FUO) is defined as fever over 7 to 10 days without a diagnosis despite a complete initial study. The most frequent causes are infections, autoimmune and tumors. Even though most cases are self-limited there is a minority that has an underlying etiology with an ominous forecast, encouraging a systematized study.
To report a rare case of a boy who presented fever of unknown origin associated to panniculitis and was diagnosed of subcutaneous panniculitis-like-T cell lymphoma and to emphasis the importance of a sequential study of FUO, in order to reach a diagnosis in patients who need a timely intervention.
A ten year old boy, previously healthy, presented subcutaneous nodular lesions of 2 month of evolution, located in abdominal region and extremities, given few symptoms, associated with prolonged fever. He was hospitalized for proper study, in first instance infectious and immune causes were discarded and through lesions biopsy the diagnose of subcutaneous panniculitis-like-T cell lymphoma was reached.
When FUO is diagnosed, most prevalent causes must be discarded. Then, differential diagnosis, such as immune and neoplasic etiologies, have to be considered. If FUO is associated to elemental nodular lesions, biopsy must be indicated early, in order to find potential malignant cases, avoiding therapeutic delay.
不明原因发热(FUO)定义为尽管进行了全面的初始检查,但发热持续7至10天仍未确诊。最常见的病因是感染、自身免疫性疾病和肿瘤。尽管大多数病例是自限性的,但仍有少数病例存在潜在病因且预后不佳,这促使进行系统的研究。
报告一例罕见的男孩病例,该男孩出现与脂膜炎相关的不明原因发热,被诊断为皮下脂膜炎样T细胞淋巴瘤,并强调对不明原因发热进行序贯研究的重要性,以便对需要及时干预的患者做出诊断。
一名10岁男孩,既往健康,出现皮下结节性病变2个月,位于腹部和四肢,症状轻微,伴有长期发热。他因进行适当检查而住院,首先排除了感染和免疫原因,通过病变活检确诊为皮下脂膜炎样T细胞淋巴瘤。
当诊断为不明原因发热时,必须排除最常见的病因。然后,必须考虑鉴别诊断,如免疫和肿瘤病因。如果不明原因发热与原发性结节性病变相关,必须尽早进行活检,以发现潜在的恶性病例,避免治疗延误。