Pyrexia of unknown origin

Question 1

What is PUO

Answer 1

Fever > 38.3 for >3 weeks without any cause identified after 3 days of hospital admission

Question 2

What are the categories of cause of PUO?

Answer 2

Infective
inflammatory/connective tissue
neoplastic
miscellaneous

Question 3

What are infective causes of PUO?

Answer 3

Abdominal abscess
disseminated TB
IE
EBV
CMV
Prostatitis

Question 4

What are neoplastic causes of PUO?

Answer 4

lymphoma 
hepatoma
hepatic mets
RCC
leukaemia
colon cance
pancreatic cancer

Question 5

What are inflammatory causes of PUO?

Answer 5

SLE
Systemic vasculitis
PMR
IBD
Sarcoidosis
Adult onset stills
Temporal arteritis

Question 6

What are miscellaneous causes of PUO

Answer 6

drug fever
DVT or PE
hyperthyroidism

Question 7

What are other Sx of PUO

Answer 7

Will depend on the cause
maybe lymphadenopathy

cough
altered mental status
hepatomegaly

Question 8

What are red flags for PUO

Answer 8

Weight loss
lethargy
night sweats
inability to perform ADL

Question 9

What Ix in PUO?

Answer 9

Will depend on other symptoms

Do bloods, ESR and CRP, urinalysis, LFTs, cultures, ANA, ANCA, RF, HIV, CXR, Ct in all

More invasive imaging if can’t identify cause

Question 10

What is Rx of PUO

Answer 10

Supportive

Only give Abx if suspected TB, IE, or steroids for suspected temporal arteritis