Evaluation of a case of Fever (Pyrexia Unknown Origin- PUO)

FEVER DIFFERENTIAL DIAGNOSIS

Dr Mohit Lathar, 9873662325                                                       

Intensivist and Internal Medicine Specialist;

Specialist in Critical Care/ Cardiology/Nephrology.

Sohna Road, Gurgaon; www.medconsult.in

DEFINITION

• TEMPORARY ELEVATION OF HYPOTHALAMIC SETPOINT

• AM TEMP.>37.2°C(98.9°F)

• PM TEMP. >37.7°C(99.9°F)

TYPES OF FEVER

• Low grade: 38 - 39 °C (100.4 - 102.2 °F)

• Moderate: 39 - 40 °C (102.2 - 104 °F)

• High grade: > 40 °C (> 104 °F)

• Hyperpyrexia: > 42 °C (> 107.6 °F) –A MEDICAL EMERGENCY

CAUSES

• infectious disease, e.g. influenza, common cold, HIV, malaria,

infectious mononucleosis, gastroenteritis, etc..

• Various skin inflammations such as boils, pimples, acne, abscess,

etc.

• Immunological diseases like lupus erythematosus, sarcoidosis,

inflammatory bowel diseases, etc..

• Tissue destruction, which can occur in hemolysis, surgery,

infarction, crush syndrome, rhabdomyolysis, cerebral hemorrhage,

etc..

• Drug fever

• directly caused by the drug (e.g. lamictal, progesterone,

chemotherapeutics causing tumor necrosis)

• as an adverse reaction to drugs (e.g. antibiotics, sulfa drugs, etc.)

• after drug discontinuation, like with heroin withdrawal

• Cancers such as Hodgkin disease (with Pel-Ebstein fever)

• Metabolic disorders like gout, porphyria, etc..

• Thrombo -embolic processes (i.e. pulmonary embolism, deep

venous thrombosis.

A proper evaluation of any high grade fever, or fever extending for more than 2-3 days, is MANDATORY