Different Causes of Pyrexia of Unknown Origin on Bone Marrow Examination- An Institutional Experience.

ABSTRACT

Petersdorf and Beeson defined pyrexia of unknown origin (PUO) as a complaint with temperature surpassing 38.30 C, developing over a period of at least three weeks, with no possible opinion reached after one week of inpatient investigation. In the present study, an attempt has been made to find out the causes of PUO based on bone marrow morphology. The range of diseases causing PUO not only seems to be determined by geographical factors, but time also plays a vital role. Bone marrow examination plays an important role in early diagnosis of core cause for PUO and is the best tool for picking haematological and non-haematological disorders in any age group.METHODSAll patients presenting with classical PUO coming to Government Medical College, Jammu, fulfilling the criteria of Petersdorf RG et al whether inpatient or outpatient over a period of two years were included in this cross-sectional study.RESULTSOut of 76 patients, 48 were males and 28 were females. Age of patients varied from 12 years to 70 years. Majority of patients were in the age group of 30-44 years comprising of 45% of total cases. Anaemia was seen in nearly 50% of cases of PUO. Most common diagnosis was neoplastic changes, seen in 20% of patients, 16% cases show megaloblastic changes, iron deficiency was seen 10 % cases, reactive myeloid hyperplasia was seen in 18% cases, haemophagocytosis in 6% cases, 5% cases showed hypocellular marrow. Among infections, malaria was the commonest constituting 5.2% cases. Out of total of 15 cases of neoplastic changes in bone marrow, majority of them were acute myeloid leukaemia seen in 40% cases.CONCLUSIONSBone marrow examination is an important investigation of PUO in arriving at an etiological diagnosis. The most frequent causes of pyrexia of unknown origin observed in children were acute lymphoblastic leukaemia, megaloblastic anaemia and haemophagocytosis, whereas in adults, the main causes were malignancies, megaloblastic anaemia and reactive myeloid hyperplasia. This study sheds light on the current spectrum of diseases causing pyrexia of unknown origin in this region.