Etiological distribution and clinical features of fever of unknown origin with pulmonary lesions in South China

INTRODUCTION

Fever of unknown origin (FUO) with pulmonary lesions is a common syndrome in respiratory diseases, which can be caused by infection, cancer, connective tissue disease and other rare diseases of South China. In patients with FUO associated with pulmonary lesions, pathogeny should be identified and followed by an appropriate treatment strategy.

OBJECTIVE

This study aimed to investigate the etiological distribution and clinical features of FUO with pulmonary lesions and to analyze the efficiency of different diagnostic methods for certain disease categories.

METHODS

Patients hospitalized at the Guangzhou Institute of Respiratory Health from July 2012 to December 2016 who had fever ≥38.3°C that lasted ≥21 days, in whom the chest X-ray or computed tomography (CT) revealed definite pulmonary infiltration, and for whom, despite being examined for a week, no definitive diagnosis could be made, were considered for this study.

RESULTS

A total of 104 patients were identified as having FUO with lung lesions, and 89.4% (93/104) patients were definitively diagnosed. Infectious disease was the most common cause (46.2%, 48/104). Histopathology was instrumental in the diagnosis of the causes of FUO with pulmonary manifestations, 47.3% (44/93) patients were diagnosed through histopathology, 35.4% (17/48) with infectious disease and 55.2% (16/29) with connective tissue diseases as the etiology were definitely diagnosed using histopathology.

CONCLUSION

Most FUO with pulmonary lesions are identified during infections and autoimmune diseases. The most important diagnostic measure for FUO with pulmonary lesions is histopathology. Additionally, lung biopsy must be encouraged in multi-level hospitals in the future.

[Etiological characteristics analysis of 3 137 outpatients with vertigo or dizziness in ENT department]

Objective: To analyze the etiological characteristics of patients in department of ENT with chief complaint of vertigo or dizziness in order to reduce the rate of misdiagnosis and wrong treatment. Method: A total of 3 137 patients in department of ENT with chief complaint of vertigo or dizziness from Sep 2015 to Sep 2017 were included and the etiologies were clarified retrospectively. And in which with any of the 8 kinds of disease including benign paroxysmal positional vertigo(BPPV), vestibular neuritis, vestibular migraine (VM), Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo, posterior circulation ischemia (PCI) together 2 138 patients were further stratified analyzed by gender and age. Result: ①Etiological characteristics of patients with vertigo or dizziness：among the 3 137 patients with vertigo or dizziness in ENT department in our hosipital, the peripheral diseases of vestibular were the most common disease with a total of 1 607 cases, accounting for 51.23%. And there were 506 cases of the central diseases of vestibular accounting for 16.13%, 382 cases of other systemic diseases accounting for 12.18%, 85 cases（2.71%）of psychogenic vertigo, 557 cases （17.76%）of unknown etiology. ②Analysis of the frequent and serious causing of patients with vertigo or dizziness: among the 2 138(68.15%) patients with vertigo or dizziness, BPPV with a total of 827 cases (26.36%) was the most prevalent,while 215(25.99%) of them were diagnosed as self-cured BPPV,vestibular neuritis and VM were the second prevalent with 420 cases (13.39%) and 329 cases (10.49%) respectively, Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo were the third prevalent with 209 cases (6.66%), 144 cases (4.59%), 102 cases (3.25%), respectively; well psychogenic vertigo and PCI were relatively rare, with respectively 85 cases (2.71%) and 22 cases (0.70%). Eotiology analysis stratified by age: The causes of vertigo or dizziness were ranged with age, and patients of 50-70 years old were most common with a total of 1 011 cases, accounting for 49.6%. Etiology analysis stratified by gender: There was gender difference in patients with vertigo or dizziness,such as BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo and psychogenic vertigo were common in female, while PCI in male insteadly. Conclusion: ①Among the patients with vertigo or dizziness, the pheripheral diseases of vestibular are the most prevalent, in which BPPV takes the highest accidence. ②Patients ranging from 50 to 70 years old take the main parts in patients with vertigo or dizziness. And there is an obvious gender difference in patients with BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo and PCI.