tailieunhanh - Chapter 019. Fever of Unknown Origin (Part 5)

In any FUO workup, the erythrocyte sedimentation rate (ESR) should be determined. Striking elevation of the ESR and anemia of chronic disease are frequently seen in association with giant-cell arteritis or polymyalgia rheumatica—common causes of FUO in patients 50 years of age. Still's disease is suggested by elevations of ESR, leukocytosis, and anemia and is often accompanied by arthralgias, polyserositis (pleuritis, pericarditis), lymphadenopathy, splenomegaly, and rash. The C-reactive protein level may be a useful cross-reference for the ESR and is a more sensitive and specific indicator of an "acute-phase" inflammatory metabolic response. Antinuclear antibody, antineutrophil cytoplasmic antibody, rheumatoid factor, and. | Chapter 019. Fever of Unknown Origin Part 5 In any FUO workup the erythrocyte sedimentation rate ESR should be determined. Striking elevation of the ESR and anemia of chronic disease are frequently seen in association with giant-cell arteritis or polymyalgia rheumatica common causes of FUO in patients 50 years of age. Still s disease is suggested by elevations of ESR leukocytosis and anemia and is often accompanied by arthralgias polyserositis pleuritis pericarditis lymphadenopathy splenomegaly and rash. The C-reactive protein level may be a useful cross-reference for the ESR and is a more sensitive and specific indicator of an acute-phase inflammatory metabolic response. Antinuclear antibody antineutrophil cytoplasmic antibody rheumatoid factor and serum cryoglobulins should be measured to rule out other collagen vascular diseases and vasculitis. Elevated levels of angiotensin-converting enzyme in serum may point to sarcoidosis. With rare exceptions the intermediate-strength purified protein derivative PPD skin test should be used to screen for tuberculosis in patients with classic FUO. Concurrent control tests such as the mumps skin test antigen Aventis-Pasteur Swiftwater PA should be employed. It should be kept in mind that both the PPD skin test and control tests may yield negative results in miliary tuberculosis sarcoidosis Hodgkin s disease malnutrition or AIDS. Noninvasive procedures should include an upper gastrointestinal contrast study with small-bowel follow-through and colonoscopy to examine the terminal ileum and cecum. Colonoscopy is especially strongly indicated in the elderly. Chest x-rays should be repeated if new symptoms arise. Sputum should be induced with an ultrasonic nebulizer for cultures and cytology. If there are pulmonary signs or symptoms bronchoscopy with bronchoalveolar lavage for cultures and cytology should be considered. High-resolution spiral CT of the chest and abdomen should be performed with both IV and oral contrast. If a .