Fever of unknown origin as the first manifestation of extra-pulmonary tuberculosis:analysis of 23 cases

SHI Miao; WANG Chao; HUANG Guangwei; WANG He; SU Yanli; HU Lan; MIAO Bin; QI Wenjie

doi:10.3969/j.issn.1671-6450.2018.03.021

Abstract：Objective To summarize the clinical characteristics and diagnostic strategy of extra-pulmonary tuberculo-sis (EPTB) whose initial manifestation is fever of unknown origin (FUO). Methods Retrospectively analyzed the clinical data of 23 patients of FUO who were hospitalized in Beijing Friendship Hospital during March 2013 to April 2017 and diag-nosed as EPTB. Results After admission,17 cases of erythrocyte sedimentation rate were increased. T cell spot test for tu-berculosis infection was detected in 13 of 18 cases. Positive 5 cases of 16 cases of anti-tuberculosis antibody test, tuberculin test in 14 cases of strong positive 8 cases,6 cases of tuberculosis related change of the lesion site in 16 patients with imaging examination, pathological examination of 8 cases of positive 5 cases. In 23 patients, 3 cases of urinary tuberculosis (13.0%),tuberculous lymphadenopathy in 3 cases(13.0%),3 cases of tuberculous pericardial effusion(13.0%),2 ca-ses of lumbar tuberculosis (8.7%), intestinal tuberculosis, peritoneal tuberculosis, tuberculous meningitis, tuberculosis of the hip joint,pelvic tuberculosis,renal tuberculosis,chest wall tuberculosis with 1 case respectively (4.3%), tuberculosis (infection unknown) of 5 cases(21.7%).In 23 patients,21 cases were treated with anti-tuberculosis drugs,including 7 ca-ses of HE or HZ,9 cases of HRE plan,5 cases of HRSE, HRZE or HRZS,2 cases were not treated with anti-tuberculosis treatment,and transferred directly to specialist hospitals. Conclusion EPTB With FUO as the first manifestation has the characteristics of incidence hidden,long duration and the diagnosis difficult. When Experiential anti-infection treatment is less effective,EPTB should be considered.