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Fever of unknown origin (FUO): CMV infectious mononucleosis or lymphoma?

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Abstract

Fever of unknown origin (FUO) refers to fevers of > 101 °F that persist for > 3 weeks and remain undiagnosed after a focused inpatient or outpatient workup. FUO may be due to infectious, malignant/neoplastic, rheumatic/inflammatory, or miscellaneous disorders. The FUO category determines the focus of the diagnostic workup. In the case presented of an FUO in a young woman, there were clinical findings of both CMV infectious mononucleosis or a lymphoma, e.g., highly elevated ESR, elevated ferritin levels, and elevated ACE level, β-2 microglobulins. The indium scan showed intense splenic uptake. Lymph node biopsy, PET scan, and flow cytometry were negative for lymphoma. CMV infectious mononucleosis was the diagnosis, and she made a slow recovery.

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References

  1. Cunha BA (2007) Fever of unknown origin: clinical overview and perspective. In: Cunha BA (ed) Fever of unknown origin. Informa Healthcare, New York, pp 1–8

    Chapter  Google Scholar 

  2. Cunha BA (2007) Fever of unknown origin: focused diagnostic approach based on clinical clues from the history, physical examination and laboratory tests. Infect Dis Clin N Am 21:1137–1187

    Article  Google Scholar 

  3. Carlstrom G, Alden J, Belfrage S, Hedenström G, Holmberg L, Nordbring F, Sterner G (1968) Acquired cytomegalovirus infection. British Med J 2:521–525

    Article  CAS  Google Scholar 

  4. Cohen JI, Corey GR (1985) Cytomegalovirus infection in the normal host. Medicine (Baltimore) 64:100–114

    Article  CAS  Google Scholar 

  5. Cunha BA (2010) Cytomegalovirus pneumonia: community-acquired pneumonia in immunocompetent hosts. Infect Dis Clin N Amer 24:147–158

    Article  Google Scholar 

  6. Cunha BA, Hage JE, Nouri Y (2012) Fever of unknown origin (FUO) in an immunocompetent adult due to cytomegalovirus (CMV) with polyclonal gammopathy. Infection 40:327–330

    Article  PubMed  CAS  Google Scholar 

  7. Cunha BA, Sivarajah T, Jimada I (2017) Sarcoidosis with fever and splenic infarct due to CMV or lymphoma? Heart Lung 46:394–396

    Article  PubMed  Google Scholar 

  8. Eddelston M, Peacock S, Juniper M, Warrell DA (1997) Severe cytomegalovirus infection in immunocompetent patients. Clin Infect Dis 24:52–56

    Article  Google Scholar 

  9. Cunha CB (2017) Infectious disease differential diagnosis. In: Cunha BA (ed) Antibiotic Essentials, 15th edn. Jay Pee Medical Publishers, New Delhi

    Google Scholar 

  10. Ho M (1991) Cytomegalovirus: biology and infection, 2nd edn. Plenum, New York

    Book  Google Scholar 

  11. Horwitz CA, Henle W, Henle G, Snover D, Rudnick H, Balfour HH Jr et al (1986) Clinical and laboratory evaluation of cytomegalovirus- induced mononucleosis in previously healthy individuals. Report of 82 cases. Medicine (Baltimore) 65:124–134

    Article  CAS  Google Scholar 

  12. Horowitz CA, Henle W, Henle G (1979) Diagnostic aspects of the cytomegalovirus mononucleosis syndrome in previously healthy persons. Postgrad Med 66:153–158

    Article  Google Scholar 

  13. Manfredi R, Calza L, Chiodo F (2006) Primary cytomegalovirus infection in otherwise healthy adults with fever of unknown origin: a 3-year prospective survey. Infection 34:87–90

    Article  PubMed  CAS  Google Scholar 

  14. Nolan N, Halai U, Regunath H, Smith LP, Rojas-Moreno C, Salzer W (2017) Primary cytomegalovirus infection in immunocompetent adults in the United States—a case series. ID Cases 10:123–126

    PubMed  PubMed Central  Google Scholar 

  15. Pass RF (2001) Cytomegalovirus. In: Knipe DM, Howley PM (eds) Field virology, vol 2, 4th edn. Lippincott, Williams & Wilkins, Philadelphia, pp 2675–2705

    Google Scholar 

  16. Griffiths PD, Emery VC, Milne R (2009) Cytomegalovirus. In: Richman DD, Whitley RJ, Hayden FG (eds) Clinical virology, 3rd edn. ASM Press, Washington DC, pp 475–506

    Google Scholar 

  17. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME (2008) Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 5:47

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ross SA, Novak Z, Pati S, Boppana SB (2011) Overview of the diagnosis of cytomegalovirus infection. Infect Disord Drug Targets 11(50):466–474

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Sterner G, Agell BO, Wahren B, Espmark A (1970) Acquired cytomegalovirus infection in older children and adults. Scand J Infect Dis 2:95–103

    Article  PubMed  CAS  Google Scholar 

  20. Wreghit TG, Teare EL, Sule O, Devi R, Rice P (2003) Cytomegalovirus infection in immunocompetent patients. Clin Infect Dis 37:1603–1606

    Article  Google Scholar 

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Authors and Affiliations

  1. Infectious Disease Division, NYU Winthrop Hospital, 222 Station Plaza North (Suite #432), Mineola, NY, 11501, USA

    Burke A. Cunha & Karishma Chawla

  2. School of Medicine, State University of New York, Stony Brook, New York, USA

    Burke A. Cunha & Karishma Chawla

Authors
  1. Burke A. Cunha
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  2. Karishma Chawla
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Correspondence to Burke A. Cunha.

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The authors declare that they have no conflict of interest.

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Cunha, B.A., Chawla, K. Fever of unknown origin (FUO): CMV infectious mononucleosis or lymphoma?. Eur J Clin Microbiol Infect Dis 37, 1373–1376 (2018). https://doi.org/10.1007/s10096-018-3262-2

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  • DOI: https://doi.org/10.1007/s10096-018-3262-2

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