Mourad et al proposed an algorithm for evaluating a person who meets the criteria for fever of unknown origin (FUO). The authors are from the University of Toronto, St. Michael's Hospital and Mt Sinai Hospital in Toronto.
Consider
Evaluation
drug fever
Discontinue all nonessential medications and see if fever resolves within 72 hours.
occult tumor or abscess
Perform appropriate imaging studies which may include abdominal CT, technetium based nuclear scans and/or PET scans. Biopsy and/or culture any focus identified
bacterial endocarditis
Perform echocardiography to detect vegetations or valvular lesions.
thrombophlebitis
Perform Doppler imaging studies on the legs and treat with low molecular weight heparin if positive.
temporal arteritis if > 50 years old
Biopsy a branch of the temporal artery.
where:
• Switching essential drugs to an unrelated type should also be considered.
If the workup is negative and the patient is clinically deteriorating then consider:
(1) liver biopsy
(2) laparoscopy
If no diagnosis is evident after all steps are completed, then consider the cause undiagnosed and follow the patient clinically.
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