1. PUO 4) Others
Definition: • Drug fever
• Fever >3 wks (> 38.3 oC) • Pulm embolism/DVT
• Resists Dx after 1 wk of invx • Crohn's disease / Ulcerative colitis
• Sarcoidosis
Causes: • Amyloidosis
1) Infections • Stroke/ICH
• Lung –empyema, abscess, TB do CXR, and culture sputum, urine
and gastric aspirate History
• Heart—endocarditis, rheum fever • Fever onset and pattern, duration
• Liver -- abscess, • Rashes / itch
• GU/GI: subphrenic, perinephric, pelvic, UTI • Night sweats
• Bacterial - salmonella, brucella, borrelia, leptospirosis - do • Lumps / lymphadenopathy
WWF(Widal Weil Felix) test Widal for S typhi and paratyphi, WF for • Diarrhoea
Rickettsia • Drugs
• Malaria • Immunization hx
• Dengue fever • LOA/LOW
• Melioidosis • travel hx up to a year ago
• Fungi • Contact, Sexual hx
• HIV • IV drug abuse, blood transfusions
• Other granulomas - actinomycosis, toxoplasmosis • Immunosuppressive illness
• Parasites - amoebic liver abscesses, schistosomiasis, • Pets / animal contact
trypanosomiasis • Insect bites / cuts
2) Neoplasms Physical exam:
• Lymphomas - commonest malignancy in PUO • Teeth
• Solid tumours eg RCC, colon CA, HCC • Rectal/ vaginal exam
• Skin and mucosal lesions
3) Connective tissue disease • Lymphadenopathy
• RA • Hepatosplenomegaly
• SLE • Joints examination
• PAN
• Kawasaki disease Invxs:
• Giant cell arteritis • FBC, WBC d/dx count, blood films for malaria, ESR, CRP, U/E/Cr
• Still's disease • LFT
• polymyalgia rheumatica • blood C/S - several repeat cultures. If on ABx, may need to stop for
48-72 h b4 taking blood. At least 2x sets at 2 diff sites 30 min apart.

2. WWF, PBF, Serologies (dengue, Rickettesial typhi, Orientia
tsutsugamushi, leptospirosis etc etc)
• Sputum - culture and microscopy/AFB/fungal/cytology
• Urine - dipstick, microscopy, culture
• Stool - ova, cysts and parasites
• CXR
• Rh factor, ANA, ds-DNA, anti-streptolysin titre, cryoglobulins, ANCA
• Mantoux test
• ECG
• Lumbar puncture
• Bone marrow aspirate, LN Bx
• Temporal artery biopsy
• PSA, CEA
• CT abdo, IVU, barium studies, exploratory laparotomy
• Liver biopsy
Trial of Rx:
Treat as for TB, endocarditis, vasculitis.
Trial of aspirin /steroids
Digitally signed by DR WANA HLA SHWE
DN: cn=DR WANA HLA SHWE, c=MY,
o=UCSI University, School of Medicine, KT-
Campus, Terengganu, ou=Internal Medicine
Group, email=wunna.hlashwe@gmail.com
Reason: This document is for UCSI year 4
students.
Date: 2009.02.22 15:21:23 +08'00'