Recurrent (or episodic) fever of unknown origin (FUO) as a variant subgroup of classical FUO: a French Multicenter Retrospective study of 170 patients

N Ratti; K H Ly; S Dumonteil; M François; L Sailler; M Lambert; A Hot; G Gondran; S Palat; H Bezanahary; E Desvaux; N Aslanbekova; S Parreau; A L Fauchais; P Sève; E Liozon

doi:10.1016/j.clinme.2024.100202

Recurrent (or episodic) fever of unknown origin (FUO) as a variant subgroup of classical FUO: a French Multicenter Retrospective study of 170 patients

Clin Med (Lond). 2024 Apr 18:100202. doi: 10.1016/j.clinme.2024.100202. Online ahead of print.

Authors

N Ratti¹, K H Ly¹, S Dumonteil², M François³, L Sailler⁴, M Lambert⁵, A Hot⁶, G Gondran¹, S Palat¹, H Bezanahary¹, E Desvaux¹, N Aslanbekova¹, S Parreau¹, A L Fauchais¹, P Sève⁷, E Liozon¹

Affiliations

¹ Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren).
² Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren). Electronic address: stephanie.dumonteil@chu-limoges.fr.
³ Departments of Internal Medicine, University Hospitals of Lyon Sud (Pierre-Bénite).
⁴ Departments of Internal Medicine, University Hospitals of Toulouse (Purpan).
⁵ Departments of Internal Medicine, University Hospitals of Lille (Claude Huriez).
⁶ Departments of Internal Medicine, University Hospitals of Lyon (Édouard Herriot).
⁷ Departments of Internal Medicine, University Hospitals of Lyon (La Croix-Rousse).

PMID: 38642612
DOI: 10.1016/j.clinme.2024.100202

Abstract

Background: Recurrent-FUO (fever of unknown origin) is a rare subtype of FUO for which diagnostic procedures are ill-defined and outcome data are lacking.

Methods: We performed a retrospective multicentre study of patients with recurrent-FUO between 1995 and 2018. By multivariate analysis, we identified epidemiological, clinical, and prognostic variables independently associated with final diagnosis and mortality.

Results: Of 170 patients, 74 (44%) had a final diagnosis. Being ≥ 65 years of age (OR=5.2; p<0.001), contributory history (OR=10.4; p < 0.001), and abnormal clinical examination (OR=4.0; p=0.015) independently increased the likelihood of reaching a diagnosis, whereas lymph node and/or spleen enlargement decreased it (OR = 0.2; p=0.004). The overall prognosis was good; 58% of patients recovered (70% of those with a diagnosis). Twelve (7%) patients died; patients without a diagnosis had a fatality rate of 2%. Being ≥ 65 years of age (OR = 41.3; p < 0.001) and presence of skin signs (OR = 9.5; p = 0.005) significantly increased the risk of death.

Conclusion: This study extends the known yield of recurrent-FUO and highlights the importance of repeated complete clinical examinations to discover potential diagnostic clues during follow- up. Moreover, their overall prognosis is excellent.