Differential Diagnosis of recurrent fevers

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.
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