Infectious Disease Book

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Fever of Unknown Origin Causes

Aka: Fever of Unknown Origin Causes
  1. See Also
    1. Fever
    2. Fever of Unknown Origin
    3. Drug-Induced Fever
    4. Fever of Unknown Origin Causes by Age
    5. Fever in the Returning Traveler
    6. Fever of Unknown Origin Causes in Comorbid Conditions
    7. Fever of Unknown Origin History
    8. Fever of Unknown Origin Examination
  2. Background
    1. Most cases of Fever of Unknown Origin are by a limited list of common causes presenting uncommonly (see below)
  3. Causes: Common
    1. Infectious common causes (20-40% of cases)
      1. Bacterial common causes
        1. Abdominal or pelvic abscess
        2. Cat Scratch Disease
        3. Dental abscess
        4. Endocarditis
        5. Osteomyelitis
        6. Sinusitis
        7. Tick-Borne Disease
        8. Tuberculosis
        9. Urinary Tract Infection
      2. Viral common causes
        1. Epstein Barr Virus (EBV)
          1. Accounts for 50% children with Fever of Unknown Origin (most common <6 years old)
          2. Consider even in the absence of Pharyngitis and Lymphadenopathy
        2. Cytomegalovirus
        3. Acute HIV Infection
    2. Cancer common causes (20-30% of cases)
      1. Leukemia
      2. Lymphoma
      3. Colorectal Cancer
    3. Inflammatory common causes (10-30% of cases)
      1. Connective tissue disease
        1. Still's Disease
        2. Rheumatoid Arthritis
        3. Systemic Lupus Erythematosis
      2. Granulomatous disease
        1. Crohn's Disease
        2. Sarcoidosis
      3. Vasculitic disease
        1. Polymyalgia Rheumatica or Giant Cell Arteritis
    4. Miscellaneous (10-20% of cases)
      1. Drug-Induced Fever
      2. Factitious fever
      3. Venous Thromboembolism
      4. Thyroiditis
  4. Causes: Viral infections
    1. Cytomegalovirus
    2. Epstein-Barr Virus (Mononucleosis)
    3. Acute HIV Infection
  5. Causes: Bacterial Infections
    1. Systemic infection
      1. Septicemia
      2. Streptococcosis
    2. Vector Borne Disease, foodborne disease, or other animal vectors
      1. Lyme Disease
      2. Malaria
      3. Typhoid Fever or Enteric Fever
      4. Psittacosis
      5. Brucellosis
      6. Cat Scratch Disease
    3. Head and neck infection
      1. Acute Sinusitis
      2. Dental Abscess
      3. Tonsillitis or Peritonsillar Abscess
      4. Herpes Simplex Virus (including HSV Encephalitis)
    4. Chest infection
      1. Pneumonia
      2. Subacute Bacterial Endocarditis (SBE)
      3. Tuberculosis
    5. Gastrointestinal infection
      1. Liver or biliary Infection
      2. Abdominal or Pelvic Abscess
    6. Genitourinary infection
      1. Pyelonephritis or Urinary Tract Infection
      2. Gonorrhea (may present as Gonococcal Arthritis)
      3. Prostatitis
    7. Musculoskeletal infection
      1. Osteomyelitis
    8. Neurologic infection
      1. Meningitis
      2. Encephalitis
  6. Causes: Neoplastic Disease
    1. Leukemia
    2. Lymphoma
    3. Sarcoma
    4. Carcinomatosis
    5. Renal Cell Carcinoma
    6. Colon Cancer
    7. Pancreatic carcinoma
    8. Hepatoma
    9. Metastatic cancer
  7. Causes: Autoimmune Disease
    1. See Fever in Rheumatic Disease
    2. Juvenile Rheumatoid Arthritis (evanescent rash)
    3. Henoch-Schonlein Purpura
    4. Systemic Lupus Erythematosus
    5. Rheumatic Fever (Migratory polyarthritis)
    6. Polymyalgia Rheumatica
    7. Temporal Arteritis
    8. Inflammatory Bowel Disease
    9. Reiter's Syndrome
  8. Causes: Heritable Disease
    1. Fabry's Disease
    2. Familial Mediterranean fever
    3. Lamellar Ichthyosis
    4. Nephrogenic Diabetes Insipidus
    5. Anhydrotic ectodermal dysplasia
    6. Familial Dysautonomia
  9. Causes: Granulomatous Disease
    1. Sarcoidosis
    2. Granulomatous Hepatitis
    3. Inflammatory Bowel Disease
  10. Causes: Medication (1-3% of cases)
    1. See Drug-Induced Fever
  11. Causes: Miscellaneous
    1. Factitious Fever (Munchausen by proxy)
    2. Thyroiditis
    3. Neurogenic Fever
    4. Milk Allergy
    5. Behcet's Syndrome
    6. Anicteric Hepatitis
    7. Pulmonary Embolism
    8. Deep Vein Thrombosis
  12. References
    1. Hersch (2014) Am Fam Physician 90(2): 91-6 [PubMed]
    2. Zenone (2006) Scand J Infect Dis 38(8): 632-8 [PubMed]

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