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Fever of unknown origin: case progression

BMJ 2006; 333 doi: (Published 07 September 2006) Cite this as: BMJ 2006;333:541
  1. R Sivakumar, specialist registrar, general medicine (,
  2. S Pavulari, senior house officer, general medicine1,
  3. S Ellis, consultant physician and rheumatologist1
  1. 1 Lister Hospital, Stevenage, Hertfordshire SG1 4AB
  1. Correspondence to: R Sivakumar

    Last week (2 September, p 484) we presented the case of a 19 year old student who had a swinging fever of unknown origin. The differential diagnoses after initial investigations include malignancy (particularly lymphoma), sarcoidosis, connective tissue disease, vasculitis, and infective causes including tuberculosis, fungal infection, endocarditis, and HIV. She had no relevant risk factors for HIV, but sexual histories can be initially unreliable, particularly if taken in the presence of relatives. Although the initial presentation was consistent with viral illnesses such as infectious mononucleosis, they were excluded on serological tests.

    Fig 1

    Patient's chest radiograph

    Three weeks after admission she continued …

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