Fever of unexplained genesis (clinical case)

Abstract

Fever of unexplained genesis was and remains one of the diagnostic challenges for the doctor. In the classic version with daily hyperthermia above 38 °C, this syndrome, of course, is not a very frequent pathology, but such a clinical case extremely mobilizes the doctor, he becomes like a detective. A patient who suffered from fever over 38 °C for 4 months turned to the center of clinical medicine at the IFNMU University Hospital. There were no special complaints: only fever, general weakness and lack of appetite in such periods. In dynamics, a period of normalization of temperature was observed after the use of a β-lactam antibiotic prescribed for a probable exacerbation of bronchitis. Subsequently persistent fever, daily use of non-steroidal anti-inflammatory drugs (NSAIDs) were observed. Outpatient and inpatient studies were conducted, the conclusions in which were not narrowed, but expanded the range of search. The search was carried out in the following areas: oncology, specific lung damage (tuberculosis), diffuse connective tissue diseases, local and generalized infections. Without answers to many questions (genesis of nodular formations in the lungs, mediastinal lymphoadenopathy, systemic connective tissue diseases), at a certain stage we focused on minimal objective, anamnestic, laboratory and instrumental signs of urinary system infection (exacerbation of chronic epididymitis and chronic prostatitis). The prescribed empirical therapy from the second day kept the temperature subfebrile, and from the 4th
day of the use of cefotaxime, the temperature increase was no longer noted. Our clinical case confirmed the well-known view that «the atypical course of a typical disease is more common than the typical course of a rare disease».