scholarly journals Fever of Unknown Origin as a Sole Presentation of Subacute Thyroiditis in an Elderly Patient: A Case Report with Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Rishi Raj ◽  
Srujana Yada ◽  
Aasems Jacob ◽  
Dileep Unnikrishnan ◽  
Wael Ghali
Keyword(s):  
Elderly Patient ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Subacute Thyroiditis ◽  
Thyroid Function Tests ◽  
Laboratory Studies ◽  
High Index Of Suspicion ◽  
Very High ◽  
Rule Out

An 80-year-old Caucasian male presented with fever of 3-week duration. Outpatient workup for infectious etiologies was negative and due to persistent fever, he was hospitalized for further evaluation of fever of unknown origin (FUO). Physical examination and laboratory studies remained unremarkable; however a follow-up CT scan of chest, abdomen, and pelvis with contrast done to rule out malignancy as an underlying cause of FUO revealed heterogeneous thyroid gland with surrounding hazy changes suggestive of thyroiditis. Thyroid function tests confirmed the diagnosis of subacute thyroiditis. The patient was started on prednisone with good response in his symptoms and was eventually discharged to home. The importance of our case lies in the fact that diagnosing subacute thyroiditis in the absence of classical symptoms of neck pain can be challenging and a physician should have a very high index of suspicion especially in an elderly patient where FUO can be the sole presentation.

scholarly journals Fever of unknown origin as the major manifestation of subacute thyroiditis

2021 ◽  
Vol 2021 ◽  
Author(s):  
Ahmad Housin ◽  
Marc P Pusztaszeri ◽  
Michael Tamilia
Keyword(s):  
Fever Of Unknown Origin ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Signs And Symptoms ◽  
Medical Problem ◽  
Subacute Thyroiditis ◽  
Endocrine Disorders ◽  
List Type ◽  
Thyroid Function Tests ◽  
Markers Of Inflammation

Summary Fever of unknown origin is a commonly encountered medical problem. Most common causes include infections, malignancy, and connective tissue diseases. Endocrine causes are rare but are well documented. While fever is common in some endocrine disorders, fever of unknown origin as the sole presenting feature is very rare. We describe a case report of a 63-year-old male who presents with fever of unknown origin. Imaging and biopsy results confirmed the diagnosis of subacute thyroiditis. He was started on prednisone with a good response. We conclude that subacute thyroiditis should be considered in the work up of fever of unknown origin even in the absence of classical signs and symptoms. Learning points Fever of unknown origin is a rare sole presentation of subacute thyroiditis. The classic signs and symptoms may not be manifest at the time of presentation. Normal thyroid function tests and elevated markers of inflammation often make infections, malignancy and autoinflammatory conditions the prime consideration. Imaging of the thyroid gland may point to a morphologic aberration and prompt a thyroid biopsy. After exclusion of infection, a rapid response to steroids may be both diagnostic and therapeutic.

scholarly journals Case Report: De Quervain’s Thyroiditis as a Long-Term Sequelae Complication to SARS-CoV-2 Infection

2021 ◽  
pp. 64-70
Author(s):  
Mark Kong ◽  
Sarah La Porte
Keyword(s):  
Case Report ◽  
Thyroid Function ◽  
Elevated Serum ◽  
Subacute Thyroiditis ◽  
Thyroid Function Tests ◽  
Thyroid Function Testing ◽  
Neck Lump ◽  
Function Testing

A 44-year-old man presented with an enlarged painful lower anterior neck lump with elevated serum concentrations of free thyroxine (T4) and tri-iodothyronine (T3), alongside the presence of antithyroid peroxidase antibodies. Prior to presentation, the patient was demonstrating recovery from a SARS-CoV-2 infection that required sedation, intubation, and invasive ventilation in the intensive care unit (ICU) for 11 days. Ultrasound examination of the thyroid demonstrated features of De Quervain’s (subacute) thyroiditis. This corresponded to the clinical picture, and continuous thyroid function tests were arranged. Emerging evidence throughout the SARS-CoV-2 pandemic describes the long-term sequelae of the infection, including developing atypical effects on the thyroid gland. This case report emphasises the association of painful subacute thyroiditis with post-viral infection and its manifestation during recovery from severe SARS-CoV-2, suggesting that follow-up thyroid function testing should be considered in patients discharged from the ICU who develop neck discomfort.

Behcet Disease: Long-term Follow-up of Three Children and Review of the Literature

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 986-992
Author(s):  
Yardena Rakover ◽  
Hanna Adar ◽  
Itamar Tal ◽  
Yaron Lang ◽  
Amos Kedar
Keyword(s):  
Fever Of Unknown Origin ◽  
Age Of Onset ◽  
Unknown Origin ◽  
Behçet Disease ◽  
Behcet Disease ◽  
Cns Involvement ◽  
Course Of Illness ◽  
Long Term Follow Up

Behcet disease is rare in children. There are only two reports of Behcet disease in childhood, describing seven patients. Three pediatric patients are described, in whom the age of onset ranged from 6 to 11 years. Aphthous stomatitis and arthritis were present in all of the patients; genital ulcers, iridocylitis, erythema nodosum, and CNS involvement were present in two patients. Other manifestations included Stevens-Johnson-like eruption, fever of unknown origin, and testicular involvement. All of the patients responded to glucocorticoids; two were also treated with colchicine and one was treated with chlorambucil. In two patients, follow-up of more than 10 years was done, with complete cure in one patient and benign course of illness in the other. Because of the rarity of the disease in childhood and the difficulty in making the diagnosis, there is not enough awareness by pediatricians concerning this disease.

Long-Term Follow-up of Children with Fever of Unknown Origin

2000 ◽  
Vol 39 (12) ◽  
pp. 715-717 ◽  
Author(s):  
Julie-An M. Talano ◽  
Ben Z. Katz
Keyword(s):  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Long Term Follow Up

scholarly journals Can Subacute Thyroiditis Be a Cause of Fever of Unknown Origin?

Cureus ◽  
2021 ◽  
Author(s):  
Bhagyalakshmi Satyanarayan ◽  
Anupama Sahu ◽  
Satish K Prasad ◽  
Sarita Kumari
Keyword(s):  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Subacute Thyroiditis

scholarly journals Intravascular Lymphoma of the Inferior Turbinate: An Unusual Rhinologic Presentation of a Rare Neoplasm

2007 ◽  
Vol 22 (1-2) ◽  
pp. 24-26 ◽  
Author(s):  
Milabelle B. Lingan ◽  
Francis V. Roasa
Keyword(s):  
Fever Of Unknown Origin ◽  
Medical Condition ◽  
Unknown Origin ◽  
Inferior Turbinate ◽  
Tertiary Hospital ◽  
Sinus Surgery ◽  
Intravascular Lymphoma ◽  
High Grade Fever ◽  
The Right ◽  
High Index Of Suspicion

Objective: To present a unique case of intravascular lymphoma of the inferior turbinate because of its rarity, unusual clinical presentation and difficulty in establishing a diagnosis. Design:      Case Report Setting:      A tertiary hospital Patient:      A 66-year-old male admitted to the hospital due to intermittent high grade fever of six months duration. Result:  The patient presented with fever of unknown origin, and exhaustive laboratory, ancillary procedures and biopsies to rule in/out infectious, autoimmune and oncologic causes were performed to arrive at a diagnosis. Nasal endoscopy revealed an enlarged, hypertrophied and violaceous right inferior turbinate with watery to mucoid discharge and septal deviation to the right confirmed by CT scans of the paranasal sinuses. Functional Endoscopic Sinus Surgery (FESS), septoplasty and turbinoplasty with biopsy revealed Intravascular Lymphoma. Chemotherapy was deferred due to the deteriorating medical condition and the patient expired 7 months after the initial onset of symptoms. Conclusion:  Patients who present with fever of unknown origin should undergo a thorough otorhinolaryngologic examination to exclude primary ENT conditions and ensure proper management. Given its rarity and multiplicity of presentation, it is extremely difficult to make a diagnosis of intravascular lymphoma. A high index of suspicion of Intravascular Lymphoma is necessary so that timely acquisition of tissue biopsy of any lesion involved will make a definite diagnosis. Keywords: Intravascular lymphoma, Fever, Fever of Unknown Origin

Cat Scratch Disease Presenting as Fever of Unknown Origin Is a Unique Clinical Syndrome

2019 ◽  
Vol 71 (11) ◽  
pp. 2818-2824 ◽  
Author(s):  
Michal Landes ◽  
Yasmin Maor ◽  
Diego Mercer ◽  
Zohar Habot-Wilner ◽  
Efraim Bilavsky ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Complete Recovery ◽  
National Registry ◽  
Clinical Syndrome ◽  
Ocular Disease ◽  
Mediastinal Lymphadenopathy ◽  
Cat Scratch Disease ◽  
Relapsing Fever

Abstract Background Fever of unknown origin (FUO) is a rare manifestation of cat scratch disease (CSD). Data regarding CSD-associated FUO (CSD-FUO), particularly in adults, are limited. We aimed to study disease manifestations and long-term clinical outcome. Methods A national CSD surveillance study has been conducted in Israel since 1991. Data are obtained using questionnaires, review of medical records, and telephone interviews. FUO was defined as fever of ≥14 days without an identifiable cause. CSD-FUO patients were identified in the 2004–2017 CSD national registry. Follow-up included outpatient clinic visits and telephone/e-mail surveys. Results The study included 66 CSD-FUO patients. Median age was 35.5 years (range, 3–88). Median fever duration was 4 weeks (range, 2–9). Relapsing fever pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal osteomyelitis (6%) were the most common. Malignancy, particularly lymphoma, was the initial radiological interpretation in 21% of patients; 32% underwent invasive diagnostic procedures. Of the 59 patients available for follow-up (median duration, 31 weeks; range, 4–445), 95% had complete recovery; 3 patients remained with ocular sequelae. Conclusion This is the first attempt to characterize CSD-FUO as a unique syndrome that may be severe and debilitating and often mimics malignancy. Relapsing fever is a common clinical phenotype. Multiorgan involvement is common. Recovery was complete in all patients except in those with ocular disease.

scholarly journals Threat of scrub typhus in post-earthquake Nepal

2017 ◽  
Vol 6 (4) ◽  
pp. 1-6 ◽  
Author(s):  
S Thapa ◽  
L B Sapkota ◽  
P Hamal
Keyword(s):  
Fever Of Unknown Origin ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Serum Samples ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Recent Outbreak ◽  
High Index Of Suspicion ◽  
A Prospective Study

Scrub typhus is a potentially fatal zoonotic infection, reported from many parts of Asia including Nepal. There is in­creasing reports of outbreak of Scrub typhus, after the earthquake hit Nepal on April 25, 2015. The recent outbreak of Scrub typhus posed problems in diagnosis and treatment of the disease. It may be related to poor awareness of the disease or lack of suspicion for Scrub typhus which often presents with clinical features indistinguishable from typhoid fever. Since, various parts of Nepal appeared to be suitable hubs for Scrub typhus, the clinical suspicion of Scrub typhus in the differential diagnosis of fever of unknown origin (FUO) is of utmost importance to prevent mortality and morbidity. This is a prospective study conducted in Chitwan Medical College (CMC), Chitwan, Nepal. This study was carried out over a period of 4 months extending from June 2016 to September 2016. A total of 410 serum samples were collected from all patients visiting CMC, clinically suspected of having Scrub typhus infec­tion. The samples were processed for the detection of IgM antibodies for Scrub typhus by ELISA. Results: A total of 410 samples from patients suspected with Scrub typhus infection were processed which included 200 males and 210 females. Out of total 410 samples tested, 181 (44.1%) were seropositive for Scrub typhus. Seropositivity was highest 25.9% among the age group 11-20 years of age. Females were infected more than males. This study implies the re-emergence of Scrub typhus in different regions of Nepal. Although the disease is endemic in our country, it is grossly underdiagnosed owing to non-specific clinical presentation and lack of diagnostic facilities. It is thus suggested that high index of suspicion should be maintained for cases presenting with febrile illness. Infection with Scrub typhus was found high and this calls for an urgent need to introduce vaccine against Scrub typhus. 

Wegener's granulomatosis. First case report in Bahrain

1998 ◽  
Vol 112 (7) ◽  
pp. 664-666 ◽  
Author(s):  
Ahmed Jamal ◽  
Reda Ali Ebrahim ◽  
Nabeel Tammam ◽  
Sungam Kanekar
Keyword(s):  
Wegener’S Granulomatosis ◽  
Total Population ◽  
Standard Treatment ◽  
Wegener's Granulomatosis ◽  
Cytotoxic Agents ◽  
Radiological Findings ◽  
First Case ◽  
High Index Of Suspicion ◽  
Very High

AbstractFormerly a fatal condition, Wegener's granulomatosis is now treated with good results. Although the annual incidence of Wegener's granulomatosis in the general population is not known, most European and American studies revealed an incidence in the range of one for every 250,000 of the population. The estimated total population of Bahrain as of June 1997 is 586,110; here we report the first diagnosed case of Wegener's granulomatosis in Bahrain.Our patient presented with epistaxis, and from the clinical features, the very high ESR, the operative, histopathological and the radiological findings, and a high index of suspicion we could confirm the diagnosis along with the appropriate immunological test (positive cANCA). Standard treatment with cytotoxic agents and corticosteroids has been used. On follow-up the patient has shown a progressive improvement in her clinical and laboratory parameters.

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