Abstract
Introduction: Petersdorf and Beeson defined pyrexia of unknown origin (PUO) as a complaint with temperature surpassing 38.30 C, developing over a period of at least three weeks, with no possible opinion reached after one week of inpatient investigation. In present study an attempt has been made to find out the causes of PUO based on bone marrow morphology.
Method & Materials: All the patients presenting with classical PUO coming to Government Medical College, Jammu, fulfilling the criteria of Petersdorf RG et al whether inpatient or outpatient over a period of two years were included in this prospective study.
Results: Out of 76 patients 48 were males and 28 were females. Age of patients varied from 12 years to 70 years. Majority of patients were in the age group of 30-44 years comprising of 45% of total cases.Anemia was seen in nearly 50% of cases of PUO. Most common diagnosis was neoplastic changes, seen in 20% of patients, 16% cases show megaloblastic changes, iron deficiency was seen 10 % cases, reactive myeloid hyperplasia seen in 18% cases, hemophagocytosis in 6% cases, 5% cases show hypocellular marrow. Among infections malaria was the commonest constituting 5.2% cases, Out of total 15 cases of neoplastic changes in bone marrow majority of them were acute myeloid leukemia seen in 40% cases.
Conclusion: Bone marrow examination is an important investigation of PUO in arriving at an etiological diagnosis.
Keywords: Pyrexia of unknown origin, Bone marrow examination, Malignancy, Hematological.
References
- Petersdorf RG, Beeson PB. Fever of unexplained origin: report of 100 cases. Medicine (Baltimore) 1961;40:1-30.
- De Kleijn EM, Vanderbroucke JP, Vander Meer JW. Fever of unknown origin (FUO). I. A prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. Medicine 1997; 76:392-400.
- Zehnder JL. Bone marrow aspiration and biopsy: Indications andtechnique. Website: http://www.uptodate.com/contents/bone-marrowaspiration-and-biopsy-indication-and-tec....] Retrieved on 15th April
- Kumar S, Rau AR, Naik R, Kinhi H, Mathai AM, Pai MR et al. Bonemarrow biopsy in Non Hodgkin’s lymphoma: A morphological study.Ind J Pathol Microbiol. 2009; 52(3): 332-8. 2011.
- Sipahi OR, Senol S, Arsu G et al. Pooled analysis of 857 published adult fever of unknown origin cases in Turkey between 1990-2006. Med Scimonit 2007; 13: 318-22.
- Kapoor OP. Value of bone marrow examination in patient having pyrexia of unknown origin. Website [http://www.bhj.org/journal/20024403.jul/cost 434.htm] Retrieved on 15th April 2011.
- Baruch SB, Cannani J, Braunstein R, Perry C, Ben Ezra J, Polliack A, et al. Predictive parameters for a diagnostic bone marrow biopsy specimen in the workup of fever of unknown origin. Mayo Clin Proc 2012; 87(2): 13642.
- Hot A, Jaisson I, Girard C, French M, Durand DV, Rousset H, et al. Yield of bone marrow examination in diagnosing the source of fever of unknown origin. Arch Intern Med 2009 Nov 23; 169(21): 2018-23.
- Diebold J, Molina T, Camilleri-Broet S, le Tourneau A, Audouin J. Bone marrow manifestations of infections and systemic diseases observed in bone marrow trephine biopsy. Histopathology 2000; 37: 199–211.
- Arnow PM, Flaherty JP. Fever of unknown origin.Lancet 1997;350(9077): 575-580.
- Root RK, Petersdorf RG. Fever of unknown origin. In:Root RK, Waldvogel F, Corey L, et al, eds. Clinicalinfectious diseases. A practical approach. New York:Oxford Medical Publications 1999:459-469.
- McCarthy PL. Fever. Pediatrics 1999;11:49-55.
- deKleijn EM, Vandenbroucke JP, van der Meer JW. Fever of unknown origin (FUO). A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. Medicine (Baltimore) 1997;76(6):392-400.
- Haq SA, Alam MN, Hossain SM, et al. A study of prolonged pyrexia in Dhaka. Bangladesh Med Res Counc Bull 1996;22(1):33-42.
- Knockaert DC, Vanneste LJ, Vanneste SB, et al. Fever of unknown origin in the 1980s. An update of the diagnostic spectrum. Arch Intern Med 1992;152(1):51-55.
- Davidson S. Clinical picture of pernicious anaemia priorto the introduction of liver therapy in 1926 andEdinburg subsequent to 1944. Br Med J1957;1(5013):241-243.
- Mckee LC. Fever in megaloblastic anemia. South Med J 1979;72(11):1423-1424.
- Singanayagam A, Gange N, Singanayagam A, Jones H.Folate deficiency presenting as pyrexia: a case report. Cases journal 2008, 1:275.
- Jones RV, Payne RW: The occurrence of fever in anemia. Practitioner.1960;184: 618-20.
- Diebold J, Molina T, Camilleri-Broet S, Tourneau A le, Audouin J. Bone marrow manifestations of infections and systemic diseases observed in bone marrow trephine biopsy. Histopathology 2000;37:199-211.
- Shirono K, Tsuda H. Parvovirus B19-associated hemophagocytic syndrome in healthy adults. British J. Haematol 1995;89:923-6.
- McKenna RW, Risdall RJ, Brunning RD. Virus associated hemophagocytic syndrome. Hum Pathol 1981;12:395-9.
- Janka G, Imashuku S, Elinder G, Schneider M, Henter JI. Infectionand Malignancy-Associated Hemophagocytic Syndromes. Hematology Oncology Clinics of North America 1998;12:435-44.
- Mirdha BR, Smantray JC, Mishra B, Xess I. Bone marrow Examination for Identifying Malaria in Fever of Unknown Origin. J Assoc Physicians India. 1999;47:177-9.
- Bain BJ, Clark DM, Lampert IA. Bone Marrow Pathology: Infection and Reactive Changes. 2nd ed. Blackwell Science: Oxford;1996. pp51-87.
- Jha A, Sarda R, Gupta A, Talwar OP. Bone marrow culture Vs Blood Culture in FUO. J Nepal Med Assoc. 2009;48:135-8.
- da Silva MR, Stewart JM, Costa CH. Sensitivity of bone marrow aspiration in diagnosis of visceral leishmaniasis. Am J Trop Med Hyg. 2005;72(6):811-814.
Corresponding Author
Dr Ritu Bhagat
Department of Pathology, Government Medical College, Jammu, J&K, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.93
