Fever of unknown origin physical examination
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Synonyms and keywords: febris continua e causa ignota; febris e causa ignota; febris E.C.I.; fever/pyrexia of obscured/undetermined/uncertain/unidentifiable/unknown focus/origin/source; fever/pyrexia without a focus/origin/source; FUO; PUO
Physical findings may be subtle and merit close scrutiny in the investigation of fever of unknown origin.
- A fever is often present. The periodicity of fever may have clinical significance in selected contexts.
- Physiologically, fever is accompanied by tachycardia.
- Relative bradycardia (Faget's sign) may be present in legionellosis, brucellosis, psittacosis, leptospirosis, drug fever, or factitious fever.
- Janeway lesions may be present in infective endocarditis.
- Petechiae may be present in Rocky Mountain spotted fever.
- maculopapular, vesicular, or petechial rash may be present in typhus.
- An eschar at the site of the tick bite may be present in tick-borne diseases.
- Swollen lymph nodes may be present. Lymphadenopathy may represent reactive lymphoid hyperplasia (suggestive of inflammation or infection) or underlying malignant processes such as lymphoma.
- Rose spots (blanching pink papules 2-3 mm in diameter) may be present on the trunk in salmonellosis.
- Macules, papules, and nodules may be present on the trunk and extremities in meningococcemia.
- Macules or petechiae evolving into vesicles and pustules on a hemorrhagic base may be present in disseminated gonococcal infection.
- Diffuse hyperpigmentation may be present in Whipple's disease.
- Papules and nodules evolving into crusted, verrucous growths may be present in blastomycosis.
- Warty nodules and subcutaneous abscesses may be present in coccidioidomycosis
- Erythematous papules, pustules, subcutaneous nodules, or cellulitis may be present in cryptococcosis.
- Sister Mary Joseph nodule (palpable nodule bulging into the umbilicus) may be present in metastasis of a malignant tumor in the pelvis or abdomen.
- Multiple purplish papules, nodules, and plaques may be present on the scalp, face, and neck in lymphoma.
- Multiple erythematous, painful plaques with small bumps, pustules, and vesicles may be present in Sweet's syndrome.
- Palpable purpura may be present on the lower extremities and other areas of dependency in cutaneous vasculitis.
- Temporal artery tenderness with weak pulse may be present in temporal arteritis.
- Sinus tenderness may be present in sinusitis.
- Roth's spots or conjunctival hemorrhage may be present in infective endocarditis.
- Photophobia or ocular pain on palpation suggestive of uveitis may be present in Wegener's granulomatosis, Behcet syndrome, Vogt-Koyanagi-Harada syndrome, or infections.
- Oral thrush caused by candidiasis may be present in patients with HIV/AIDS.
- Oral ulcers may be present in systemic lupus erythematosis, disseminated histoplasmosis, and Behcet syndrome.
- Tenderness with a palpable abscess may be present in periodontal disease.
- Petechiae on the palate may be present in infective endocarditis.
- Parotid gland enlargement and tenderness may be present in infections (e.g., Staphylococcus aureus, tuberculosis, mumps, HIV), Sjogren's syndrome, or sarcoidosis.
- Cervical lymph nodes may be present in inflammation, infection, lymphoma, or Kikuchi disease.
- Enlargement of the thyroid gland may be present in thyroiditis.
- Rales or rhonchi may be present in pneumonia.
- Fremitus with diminished breath sounds may be present in pneumonia.
- Heart murmurs may be present in endocarditis secondary to infections (infective endocarditis), systemic lupus erythematosus (Libman-Sacks endocarditis), or chronic diseases (marantic endocarditis)..
- Abdominal tenderness may be present in intra-abdominal infections.
- Rebound tenderness may be present in intra-abdominal infections.
- An acute abdomen may be present in intra-abdominal infections.
- Guarding may be present in intra-abdominal infections.
- Flank pain may be present in psoas muscle abscess, perinephric abscess, or pyelonephritis.
- An inguinal mass may be present in psoas muscle abscess.
- Splenomegaly may be present in infectious mononucleosis, splenic abscess, or hepatitis.
- Prostatic enlargement may be present in prostatic abscess.
- Epididymal nodule may be present in epididymitis.
- Testicular nodule may be present in polyarteritis nodosa.
- Osler's nodes may be present in infective endocarditis.
- Swollen joints with effusion may be present in infectious arthritis or rheumatic diseases.
- Splinter hemorrhage in the nail beds may be present in infective endocarditis.
- Limb tenderness along deep veins may be present in deep vein thrombosis or thrombophlebitis.
- Altered mental status may be present.
- Cranial nerve deficits may be present in cerebral vasculitis associated with systemic lupus erythematosus.
- Arnow, P. M.; Flaherty, J. P. (1997-08-23). "Fever of unknown origin". Lancet. 350 (9077): 575–580. doi:10.1016/S0140-6736(97)07061-X. ISSN 0140-6736. PMID 9284789.
- Hayakawa, Kayoko; Ramasamy, Balaji; Chandrasekar, Pranatharthi H. (2012-10). "Fever of unknown origin: an evidence-based review". The American Journal of the Medical Sciences. 344 (4): 307–316. doi:10.1097/MAJ.0b013e31824ae504. ISSN 1538-2990. PMID 22475734. Check date values in:
- Cunha, Burke A. (2007-12). "Fever of unknown origin: focused diagnostic approach based on clinical clues from the history, physical examination, and laboratory tests". Infectious Disease Clinics of North America. 21 (4): 1137–1187, xi. doi:10.1016/j.idc.2007.09.004. ISSN 0891-5520. PMID 18061092. Check date values in:
- Hirschmann, J. V. (1997-03). "Fever of unknown origin in adults". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 24 (3): 291–300, quiz 301-302. ISSN 1058-4838. PMID 9114175. Check date values in: