Knockaert D C, Dujardin K S, Bobbaers H J
Department of General Internal Medicine, Gasthuisberg University Hospital, Leuven, Belgium.
Arch Intern Med. 1996 Mar 25;156(6):618-20.
A casual diagnosis cannot be established in 10% to 25% of the patients who are studied for fever of unknown origin (FUO). The long-term clinical outcome of these patients cannot be inferred from the literature. This study describes the results of a 5-year follow-up of 61 patients studied for FUO and discharged from the hospital with no causal diagnosis being established.
Patients meeting the classic criteria for FUO who were studied in the 1980s and discharged from the hospital without a casual diagnosis were followed up for at least 5 years or until death. Follow-up was performed by review of the patients' medical records or by consulting the treating physician and occasionally the patients themselves. The final diagnosis, clinical course (resolution of the fever and required treatments), and morality rate were studied.
Of a cohort of 199 patients with FUO, 61 individuals (30%) were discharged from the hospital without a final diagnosis being established. A definite diagnosis could be established in 12 cases, mostly (eight of 12) within 2 months after discharge. Thirty-one individuals became symptom free during hospitalization or shortly following discharge. Eighteen patients had persisting or recurring fever for several months or even years after discharge, but 10 of them were considered to be finally cured. Four patients were treated with corticosteroids and six patients required intermittent therapy with nonsteroidal anti-inflammatory agents. Six patients died, but the cause of death was considered to be related to the disease that caused FUO in only two cases.
No single disease, particularly not tuberculosis, was found to be a cause of undiagnosed FUO. Most cases resolved spontaneously, and corticosteroids were seldom required. Most symptomatic patients could be treated with nonsteroidal anti-inflammatory drugs. The mortality rate in patients with undiagnosed FUO who were followed up for 5 years or more was only 3.2%.
在因不明原因发热（FUO）接受检查的患者中，有10%至25%无法做出初步诊断。这些患者的长期临床结局无法从文献中推断出来。本研究描述了61例因FUO接受检查且出院时未确诊病因的患者的5年随访结果。
对20世纪80年代符合FUO经典标准且出院时未确诊病因的患者进行至少5年的随访或直至死亡。通过查阅患者病历、咨询主治医生，偶尔也咨询患者本人来进行随访。研究最终诊断、临床病程（发热消退情况及所需治疗）和死亡率。
在199例FUO患者队列中，61例（30%）出院时未确诊。12例患者最终确诊，多数（12例中的8例）在出院后2个月内确诊。31例患者在住院期间或出院后不久症状消失。18例患者出院后持续发热或反复发热数月甚至数年，但其中10例最终被认为治愈。4例患者接受了糖皮质激素治疗，6例患者需要间断使用非甾体抗炎药治疗。6例患者死亡，但仅2例患者的死亡原因被认为与导致FUO的疾病有关。
未发现单一疾病，尤其是结核病，是未确诊FUO的病因。大多数病例可自发缓解，很少需要使用糖皮质激素。大多数有症状的患者可用非甾体抗炎药治疗。随访5年及以上的未确诊FUO患者的死亡率仅为3.2%。
