Takayasu Arteritis in an Older Man with Pulmonary Embolism / General Medicine

An 85-year-old male patient with a history of asthma and hypertension was admitted to our hospital because of a fever of unknown origin. He complained of fever, fatigue, and weakness of lower extremities, which was considered due to infection, and he was administered antibiotics. Although his fever improved, there was little improvement in his condition or laboratory data. Enhanced-contrast computed tomography showed irregular hypertrophy of the aorta with contrast effect in the outer aortic wall and pulmonary embolism. He was diagnosed with Takayasu arteritis and pulmonary embolism. His clinical condition and aortic wall enhancement improved following steroid and anticoagulant drug therapy.

<b>A Case of Recurrent Fever Successfully Treated with Yokukansan</b> / 日本東洋医学雑誌

The patient was a 14 year-old female. She had been hospitalized repeatedly since infancy for suspected tonsillitis. During this time, she experienced high fever for about a week once a month. In her school years, she often had a recurrent fever with cervical adenitis, with only a mild inflammatory reaction. We diagnosed her symptom as one of a periodic fever syndrome, triggered by the frequent administered antipyretic drugs for fevers of unknown origin (FUO). We also suspected that there was liver tension, based on her abdominal and back examination, and we prescribed yokukansan. After a 3-month course of yokukansan, she no longer experienced these fevers. Most case reports of FUO describe the use of bupleurum root drugs and tonic formulas as treatment. Although yokukansan has traditionally been used for FUO in older texts, to our knowledge, there are no reports on such use clinically. In the present patient's case, the yokukansan may have reduced or eliminated some type of trigger for the fevers, or it may have affected the regulation of cytokines.

A Case of Systemic Vasculitis Presented as Fever of Unknown Origin / 감염과화학요법

Fever of unknown origin (FUO) means fever that does not resolve spontaneously in the period expected for self-limited infection and whose cause cannot be ascertained despite considerable diagnostic efforts. We experienced a case of FUO associated with systemic vasculitis, which was diagnosed with clinical manifestation, radiographic findings, the presence of anti-neutrophil cytoplasmic antibody (ANCA), and renal biopsy. A 54-year-old female was admitted to our hospital with remittent fever of 3 months. A paranasal sinus (PNS) view revealed maxillary and ethmoidal sinusitis, and urine analysis showed microscopic hematuria. We performed a renal biopsy on the basis of positive ANCA and microscopic hematuria. The renal biopsy showed pauci-immune crescentic glomerulonephritis without granuloma, interstitial inflammation, and small vessel vasculitis. Under the diagnosis of ANCA-associated systemic vasculitis, she was treated with steroid and cyclophosphamide. She showed marked clinical improvement.

A Case of Systemic Vasculitis Presented as Fever of Unknown Origin / 감염과화학요법

Fever of unknown origin (FUO) means fever that does not resolve spontaneously in the period expected for self-limited infection and whose cause cannot be ascertained despite considerable diagnostic efforts. We experienced a case of FUO associated with systemic vasculitis, which was diagnosed with clinical manifestation, radiographic findings, the presence of anti-neutrophil cytoplasmic antibody (ANCA), and renal biopsy. A 54-year-old female was admitted to our hospital with remittent fever of 3 months. A paranasal sinus (PNS) view revealed maxillary and ethmoidal sinusitis, and urine analysis showed microscopic hematuria. We performed a renal biopsy on the basis of positive ANCA and microscopic hematuria. The renal biopsy showed pauci-immune crescentic glomerulonephritis without granuloma, interstitial inflammation, and small vessel vasculitis. Under the diagnosis of ANCA-associated systemic vasculitis, she was treated with steroid and cyclophosphamide. She showed marked clinical improvement.

A comparison of causes of fever of unknown origin between the 1980s and the 1990s / 대한내과학회지

BACKGROUND: Physicians find fever of unknown origin (FUO) a difficult problem to solve. Analysis of the causes of FUO may be useful in the diagnosis of FUO. We investigated the causes of FUO in the last two decades from 1980 to 1999 and compared the two decades to seek for a trend of changes of the causes of FUO. METHODS: Among 854 patients diagnosed as FUO on discharge, we retrospectively reviewed 278 patients compatible with the Petersdorf's criteria through inpatient and outpatient medical records. RESULTS: There were 144 (51.5%) men and 134 (48.2%) women. Among the 98 patients in the 1980s, infectious disease was the cause in 37 (37.8%) patients, collagen vascular disease in 17 (17.3%), malignancy in 8 (8.2%), miscellaneous in 11 (11.2%), and unidentifiable cause in 25 (25.5%) patients. Among the 180 patients in the 1990s, infectious disease was the cause in 45 (25.0%) patients, collagen vascular disease in 37 (20.5%), malignancy in 34 (18.9%), miscellaneous in 45 (25.0%), and unidentifiable cause in 19 (10.6%) patients. According to the order of frequency, the causes of infectious disease were pulmonary tuberculosis (19.4%), extrapulmonary tuberculosis (8.2%), liver abscess (4.1%) in the 1980s and extrapulmonary tuberculosis (17.2%), pulmonary tuberculosis (4.4%), liver abscess (1.1%) in the 1990s. The diagnostic methods for evaluation of FUO were culture (45.6%), radiology (17.6%), serology (16.2%), and biopsy (10.3%) in the 1980s and radiology (31.5%), biopsy (26.9%), culture (21.5%) and serology (20.0%) in the 1990s. CONCLUSION: Among the causes of FUO, infectious disease decreased and collagen disease and malignancy increased with time. The most common cause of infectious disease was pulmonary tuberculosis in the 1980s but extrapulmonary tuberculosis in the 1990s. Use of radiology and biopsy as diagnostic methods for FUO increased.

A Case of Transfusion Induced Malaria Presenting as a Fever of Unknown Origin / 감염

We report a case of a 39 year-old woman with transfusion-induced malaria presenting as fever of unknown origin. She had been well until 2 months ago when lower abdominal pain developed. Pelvic ultrasonography revealed an ovarian mass and an operation was performed. Two weeks after the operation, she developed a fever. Peripheral blood smear revealed developmental stages of Plasmodium vivax. The patient had received two units of whole blood during the operation, which was later proven to have been donated by a asymptomatic soldier who contracted tertian malaria while serving near the DMZ, an endemic area of malaria in South Korea. Considering such a case, malaria should be included in the differential diagnosis of post-transfusion febrile episodes.

A Case of Acute Retroviral Syndrome Presenting as a Fever of Unknown Origin / 감염

We report a case of acute retroviral syndrome presen-ting as a fever of unknown origin. A 22-year-old man was admitted to the hospital because of fever. He had been well untill 20 days earlier when he experienced fe-ver and headache. Three days before admission diarrhea, vomiting, sore throat and myalgia developed. Physical examination revealed skin rash, and multiple lymphadeno-pathy. Acute human immunodeficiency virus (HIV) infec- tion was confirmed by seroconversion. As the number of patients with HIV infection is increasing in Korea, acute retroviral syndrome should be included in the differential diagnosis of fever of unknown origin.