Ding Jing, Tian Ju, Chen Xingqi
Department of Plastic Surgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, China.
Emergency Department, Zhongshan City People's Hospital, Zhongshan, Guangdong, China.
Am J Case Rep. 2025 Aug 18;26:e948614. doi: 10.12659/AJCR.948614.
BACKGROUND Fever, defined as an elevation in body temperature beyond the normal range, presents a diagnostic and therapeutic challenge due to its multifactorial etiology. The purpose of publishing this case report is to highlight the diagnostic challenges posed by recurrent fever and emphasize the importance of a systematic and comprehensive approach, while also proposing a novel diagnostic algorithm to improve management and minimize unnecessary antibiotic use. CASE REPORT We report a case of a 26-year-old woman with recurrent fever, headache, and myalgia, unresponsive to initial antiviral and antibiotic therapies. Despite negative viral and bacterial tests, various medications failed to produce significant clinical improvement. Elevated liver function tests and procalcitonin levels suggested an atypical infection. Administration of doxycycline led to symptom alleviation; however, the diagnosis remains unconfirmed without definitive testing. This case underscores the importance of adopting a systematic and comprehensive diagnostic approach for unclear illnesses. While empirical treatment may be necessitated, caution is urged to avoid unjustified use of antibiotics and medications without a clear diagnosis. Balancing empirical therapy with thorough evaluation is crucial for effective fever management, minimizing the risks of misdiagnosis or inappropriate treatment. We propose a novel diagnostic algorithm integrating rapid molecular diagnostics and advanced imaging to minimize unnecessary antibiotic use and improve patient outcomes. CONCLUSIONS The management of recurrent febrile illnesses requires a balanced approach, integrating empirical treatment with comprehensive diagnostic evaluation. Our proposed diagnostic algorithm offers a structured pathway to improve patient outcomes and reduce unnecessary antibiotic use. Further research is essential to validate this approach and establish standardized protocols for fever management.
背景 发热定义为体温升高超出正常范围，因其病因多因素，带来了诊断和治疗方面的挑战。发表本病例报告的目的是突出反复发热所带来的诊断挑战，强调系统全面方法的重要性，同时提出一种新颖的诊断算法以改善管理并尽量减少不必要的抗生素使用。病例报告 我们报告一例26岁女性，有反复发热、头痛和肌痛症状，初始抗病毒和抗生素治疗无效。尽管病毒和细菌检测均为阴性，但各种药物治疗均未取得显著临床改善。肝功能检查和降钙素原水平升高提示非典型感染。给予强力霉素后症状缓解；然而，未经明确检测，诊断仍未得到证实。该病例强调了对不明疾病采用系统全面诊断方法的重要性。虽然可能需要经验性治疗，但应谨慎避免在未明确诊断的情况下不合理使用抗生素和药物。在经验性治疗与全面评估之间取得平衡对于有效管理发热、将误诊或不恰当治疗的风险降至最低至关重要。我们提出一种新颖的诊断算法，整合快速分子诊断和先进成像技术，以尽量减少不必要的抗生素使用并改善患者预后。结论 反复发热性疾病的管理需要一种平衡的方法，将经验性治疗与全面的诊断评估相结合。我们提出的诊断算法提供了一条结构化途径，以改善患者预后并减少不必要的抗生素使用。进一步的研究对于验证这种方法并建立发热管理的标准化方案至关重要。
