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      Enfermedad de Crohn: ¿todavía hoy causa de fiebre de origen desconocido clásica? Translated title: Crohn’s disease: is still the reason of fever of unknown origin?

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          Abstract

          Presentamos dos casos de enfermedad de Crohn que se manifestaron inicialmente como FOD, con mínima clínica intestinal. En el caso 1, la forma de debut fue fiebre intermitente acompañada de poliartritis de grandes articulaciones; en el caso 2, fiebre prolongada con dolor abdominal cólico inespecífico. En ambos el estudio diagnóstico de FOD de la primera semana fue negativo. El estudio del tubo digestivo con radiología baritada fue determinante en el diagnóstico de ambos casos, por lo que recomendamos valorar el tránsito intestinal dentro del estudio inicial de FOD de la primera semana.

          Translated abstract

          We present two patients with Crohn's disease who presented with fever unknown origin, and mild intestinal symptoms. In case 1, the debut was with intermittent fever and symmetrical polyarthritis of the wrists, elbows, ankles and knees; in the case 2, prolonged fever associated to unspecific colicky abdominal pain. The initial approach was fever unkown origin yielded no etiology in both of them. The barium studies of the intestinal tract of paramout importance to reach a positive diagnosis in both cases. We strongly recommend the use of barium studies as a first line diagnostic tool in the approach of fever unkown origin.

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          Most cited references15

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          Fever of unknown origin: review of 86 patients treated in community hospitals.

          This study describes the clinical features of fever of unknown origin (FUO) in 86 patients in a community setting from 1984 to 1990. Infectious diseases remain the most common category of illnesses causing FUO; in this study, infectious diseases including recently described diseases--such as AIDS (three cases) and Lyme disease (one case)--caused FUO in 28 patients. Although percutaneous computed tomography-guided procedures were useful for obtaining diagnostic specimens (15 cases), a noninvasive approach established the diagnosis in many instances (37 cases). In all but nine cases, diagnostic testing was guided by abnormalities detected during the physical examination or routine laboratory tests.
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            Prolonged fevers of unknown origin in children: patterns of presentation and outcome.

            To review the presentation, clinical characteristics, and outcome of children with prolonged fevers of unknown origin who are referred for pediatric rheumatologic evaluation. We used a retrospective review of the charts of the 40 children (23 boys and 17 girls, aged 9 months to 14.6 years) with fevers persisting longer than 1 month who were referred to the Pediatric Rheumatology Clinic between 1984 and 1994, in whom evaluation did not result in diagnosis. Follow-up with children's families, pediatricians, or both was done by telephone. Of the 40 children, 29 had periodic fevers, and 11 had daily fevers without pattern. Patients with periodic fever were younger at onset, had longer duration of symptoms before referral, and higher maximum temperatures. The two groups did not differ in frequency of associated symptoms or signs. At follow-up (mean 60.5 +/- 5 months, n = 37), 10 children with daily fevers (within 24 months) and 23 children with periodic fevers (within 48 months) had completely recovered; three patients continue to have periodic fevers. In patients with daily fevers one had Crohn disease (7 months after initial evaluation) and another had uveitis (4 years after evaluation). One patient with periodic fevers had inflammatory bowel disease 3.5 years after the onset of fevers. Petit mal seizures developed in one patient with periodic fever, and another had mitochondrial encephalopathy. Four children with periodic fevers have attention-deficit hyperactivity disorder, and two have developmental delays. Fevers without an obvious source usually have a benign outcome, although patients should be monitored for changes in symptoms. Of the children with periodic fevers, 29% were later found to have neurologic problems; the relation to the previous fevers is uncertain.
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              Fever of Undetermined Origin

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ami
                Anales de Medicina Interna
                An. Med. Interna (Madrid)
                Arán Ediciones, S. L. (Madrid )
                0212-7199
                April 2007
                : 24
                : 4
                : 185-186
                Affiliations
                [1 ] Hospital Universitario La Paz Spain
                Article
                S0212-71992007000400007
                10.4321/s0212-71992007000400007
                3d084ddd-33e2-4308-8011-5cf1fa37cf37

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Fever of unkown origin,Crohn's disease,Inflamatory bowel disease,Arthritis,Fiebre de origen desconocido,Enfermedad de Crohn,Enfermedad inflamatoria intestinal,Artritis

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