Abstract:

Objectives: Fever of unknown origin (FUO) is a usually challenging clinical condition for physicians. The diagnostic work-up requires invasive procedures including culture of bone marrow aspirates and bone marrow/lymph nod biopsies. In this study, we have investigated the results of diagnostic procedures employed for the work-up of FUO. Materials and Methods: Patients who were requested hematological consultation for bone marrow aspiration for culture during the work-up for FUO in the Infectious Diseases Department of Ankara Atatürk Training and Research Hospital were included in the study. Patients with detected lymphadenopathy during physical examination had also underwent pathological investigation of bone marrow and lymph nodes biopsies. Results: Bone marrow cultures revealed positive results in 6 out of 32 patients(18 male and 14 female). Two patients had simultaneous positivity of both blood and bone marrow cultures. by Brucella SPP. was detected in bone marrow cultures of two other patients. Among the bone marrow biopsies 24(75.00%) were normocellular, 6(19.00%) were hypercellular, 1(3.00%) revealed lymphoma involvement and 1(3.00%) revealed polyclonal expansion of plasma cells. Nine patients with lymphadenopathy in physical examination were performed lymph nod biopsies. Lymph node biopsies demonstrated Leishmania spp. in 1 patient, EBV in 1 patientand diffuse large B-celllymphoma in 2 patients. Conclusion: Bone marrow biopsy and culture and lymph nod biopsy are invasive diagnostic tests for the work-up of FUO. Bone marrow culture is the golden standard for the diagnosis of zoonotic infections including brucellosis and granulomatous infections including tuberculosis, as well as infiltration with leukemia and lymphoma. The value of interventional hematological procedures should not be underestimated during the work-up of FUO. The primary care physicians must be aware of this necessity and of the timing for these procedures.

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