Differential Diagnosis of recurrent fevers
What conditions need to be ruled out in patients with recurrent fevers?
- 1. Cyclic neutropenia.
- 2. Infectious disorders:
- • Hidden infectious focus (e.g., aortoenteric infection, Caroli’s disease).
- • Recurrent reinfection (host defense defect/primary immunodeficiency).
- • Specific infection (Borrelia or other relapsing fever, malaria, Whipple disease).
- 3. Noninfectious inflammatory disorders:
- • Systemic juvenile idiopathic arthritis, adult-onset Still’s disease.
- • Sarcoidosis.
- • Behçet’s disease.
- • Chronic recurrent multifocal osteomyelitis (CRMO, also called chronic noninfectious osteomyelitis [CNO]).
- • Inflammatory bowel disease (usually Crohn disease).
- • Sweet syndrome.
- • Schnitzler syndrome (IgM gammopathy, fever, urticarial rash, dermatographism, bone pain, splenomegaly, systemic symptoms; hematologic malignancy may be seen in 20% to 30%; reports of success with IL-1 inhibition).
- 4. Vascular/thromboembolic (recurrent pulmonary embolism or deep vein thrombosis).
- 5. Neoplastic:
- • Leukemia, lymphoma (including angioimmunoblastic T-cell lymphoma).
- • Solid tumor (neuroblastoma, pheochromocytoma, myxoma, colon, and renal cell carcinoma).
- • Paraneoplastic syndrome.
- 6. Hypothalamic disease.
