Fever of unknown origin physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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 Examination

Vitals

Temperature

• A fever is often present. The periodicity of fever may have clinical significance in selected contexts.

Pulse

• Weak or absent pulse may be present in Takayasu's arteritis.

Rate

• Physiologically, fever is accompanied by tachycardia.
• Relative bradycardia (Faget's sign) may be present in legionellosis, brucellosis, psittacosis, leptospirosis, drug fever, or factitious fever.

Skin

• 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.

Head

• Temporal artery tenderness may be present in temporal arteritis.

Eyes

• 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, or infections.

Mouth

• Oral thrush caused by candidiasis may be present in HIV/AIDS.
• Tenderness with a palpable abscess may be present in periodontal disease.
• Petechiae on the palate may be present in infective endocarditis.

Neck

• Cervical lymph nodes may be present in inflammation, infection, or lymphoma.

Lungs

• Rales or rhonchi may be present in pneumonia.
• Fremitus with diminished breath sounds may be present in pneumonia.

Heart

• Heart murmurs may be present in endocarditis secondary to infections (infective endocarditis), systemic lupus erythematosus (Libman-Sacks endocarditis), or chronic diseases (marantic endocarditis)..

Abdomen

• 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.

Genitourinary

• Prostatic enlargement may be present in prostatic abscess.

Extremities

• Osler's nodes may be present in infective endocarditis.
• Swollen joints may be present in infectious arthritis or rheumatic diseases.
• Splinter hemorrhage in the nail beds may be present in infective endocarditis.

Neurologic

• Altered mental status may be present.