Fever of Unknown Origin Examination

Aka: Fever of Unknown Origin Examination

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II. Signs: Skin findings suggestive of infectious pathology

  1. Petechiae or Purpura (Systemic Vasculitis)
  2. Seborrheic rash (Histiocytosis X)
  3. Perineal rash (Kawasaki's Disease)
  4. Pallor, Jaundice or soft skin (Hyperthyroidism)
  5. Sparse eyebrows (anhydrotic ectodermal dysplasia)
  6. Hair Loss or breakage (Systemic Lupus Erythematosus)
  7. Characteristic rashes
    1. Tick-borne infection (e.g. Erythema Migrans in Lyme Disease)
    2. Herpes Simplex Virus
    3. Systemic Lupus Erythematosus (e.g. Malar Rash)
    4. Sarcoidosis (e.g. Lupus Pernio, Dactylitis, Erythema Nodosum)
    5. Still's Disease
      1. Faint salmon colored rash over trunk, palms and soles
  8. Oral Ulcers
    1. Behcet Disease
    2. Systemic Lupus Erythematosus

III. Signs: Eye findings suggestive of infectious pathology

  1. Bulbar Conjunctivitis
    1. Kawasaki's Disease
    2. Leptospirosis
  2. Palpebral or Bulbar injection
    1. Systemic Lupus Erythematosus
    2. Tularemia
    3. Histoplasmosis
    4. Chlamydia
  3. Punctate Conjunctival Hemorrhages
    1. Bacterial Endocarditis
  4. No pupillary constrictor response
    1. Familial Dysautonomia
  5. Fundus lesions
    1. Toxoplasmosis
    2. Cytomegalovirus
    3. Papilledema
    4. Roth Spots
    5. Leptospirosis
  6. Uveitis
    1. Autoimmune Disease
    2. Sarcoidosis
    3. Tuberculosis
    4. Toxoplasmosis
    5. Syphilis
    6. Leptospirosis
    7. Still's Disease

IV. Signs: Hepatomegaly, Splenomegaly or abdominal mass

  1. Alcoholic Liver Disease or Cirrhosis
  2. Cancer (e.g. Hepatic Malignancy or Liver Metastases, Renal Mass)
  3. Cytomegalovirus
  4. Epstein-Barr Virus
  5. Leukemia
  6. Lymphoma
  7. Miliary Tuberculosis
  8. Q Fever (Hepatomegaly)

V. Signs: Musculoskeletal findings

  1. Joint Swelling or pain
    1. Inflammatory Bowel Disease
    2. Lyme Disease
  2. Bone findings suggestive of infectious pathology
    1. See Osteomyelitis
    2. See Vertebral Osteomyelitis
    3. Focal tenderness (assess for long bone Osteomyelitis)

VI. Signs: Lymph Node findings suggestive of infectious pathology

  1. Generalized Lymphadenopathy
    1. Autoimmune cause (e.g. Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sarcoidosis)
    2. Cat Scratch Disease
    3. Cytomegalovirus
    4. Epstein-Barr Virus
    5. Acute HIV Infection
  2. Localized or nontender adenopathy
    1. Malignancy

VII. Signs: Cardiac findings suggestive of infectious pathology

  1. Diastolic insufficiency murmurs
  2. Widened Pulse Pressure

VIII. References

  1. David (2022) Am Fam Physician 105(2): 137-43 [PubMed]

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