Structured Approach to Pts with Fever of Unknown Origin (FUO) - Flowchart
Structured Approach to Pts with Fever of Unknown Origin (FUO) - Flowchart
«Flowchart»

Fever 38.3°C (101°F) and illness lasting 3 weeks and no known immunocompromised state

Fever 38.3°C (101°F) and illness lasting 3 weeks and no known immunocompromised state

Fever 38.3°C (101°F) and illness lasting 3 weeks and no known immunocompromised state

and and

Cryoglobulin and funduscopy

Cryoglobulin and funduscopy

Cryoglobulin and funduscopy

History and physical examination

History and physical examination

History and physical examination

Stop antibiotic treatment and glucocorticoids

Stop antibiotic treatment and glucocorticoids

Stop antibiotic treatment and glucocorticoids

Obligatory investigations: ESR and CRP, hemoglobin, platelet count, leukocyte count and differential, electrolytes, creatinine, total protein, protein electrophoresis, alkaline phosphatase, AST, ALT, LDH, creatine kinase, antinuclear antibodies, rheumatoid factor, urinalysis, blood cultures (n = 3), urine culture, chest x-ray, abdominal ultrasonography, and tuberculin skin test

Obligatory investigations: ESR and CRP, hemoglobin, platelet count, leukocyte count and differential, electrolytes, creatinine, total protein, protein electrophoresis, alkaline phosphatase, AST, ALT, LDH, creatine kinase, antinuclear antibodies, rheumatoid factor, urinalysis, blood cultures (n = 3), urine culture, chest x-ray, abdominal ultrasonography, and tuberculin skin test

Obligatory investigations: ESR and CRP, hemoglobin, platelet count, leukocyte count and differential, electrolytes, creatinine, total protein, protein electrophoresis, alkaline phosphatase, AST, ALT, LDH, creatine kinase, antinuclear antibodies, rheumatoid factor, urinalysis, blood cultures (n = 3), urine culture, chest x-ray, abdominal ultrasonography, and tuberculin skin test

Obligatory investigations:

Exclude manipulation with thermometer

Exclude manipulation with thermometer

Exclude manipulation with thermometer

Stop or replace medication to exclude drug fever

Stop or replace medication to exclude drug fever

Stop or replace medication to exclude drug fever

PDCs present

PDCs present

PDCs present

PDCs absent or misleading

PDCs absent or misleading

PDCs absent or misleading

End

End

End

Guided diagnostic tests

Guided diagnostic tests

Guided diagnostic tests

DIAGNOSIS

DIAGNOSIS

DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

FDG-PET/CT (or labeled leukocyte scintigraphy or gallium scan)

FDG-PET/CT (or labeled leukocyte scintigraphy or gallium scan)

FDG-PET/CT (or labeled leukocyte scintigraphy or gallium scan)

Scintigraphy abnormal

Scintigraphy abnormal

Scintigraphy abnormal

Scintigraphy normal

Scintigraphy normal

Scintigraphy normal

Confirmation of abnormality (e.g., biopsy, culture)

Confirmation of abnormality (e.g., biopsy, culture)

Confirmation of abnormality (e.g., biopsy, culture)

DIAGNOSIS

DIAGNOSIS

DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

Repeat history and physical examination
Perform PDC-driven invasive testing

Repeat history and physical examination
Perform PDC-driven invasive testing

Repeat history and physical examination
Perform PDC-driven invasive testing


DIAGNOSIS

DIAGNOSIS

DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

Chest and abdominal CT
Temporal artery biopsy (55 years)

Chest and abdominal CT
Temporal artery biopsy (55 years)

Chest and abdominal CT
Temporal artery biopsy (55 years)


DIAGNOSIS

DIAGNOSIS

DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

NO DIAGNOSIS

Stable condition:


Follow-up for new PDCs
Consider NSAID

Stable condition:


Follow-up for new PDCs
Consider NSAID


Follow-up for new PDCs
Consider NSAID Stable condition

Deterioration:


Further diagnostic tests
Consider therapeutic trial

Deterioration:


Further diagnostic tests
Consider therapeutic trial


Further diagnostic tests
Consider therapeutic trial Deterioration