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ORIGINAL ARTICLE
Korean J Pediatr 2017 March;60(3) :77-85.
Published online 2017 March 15.       
Etiology and clinical characteristics of fever of unknown origin in children: a 15-year experience in a single center
Yi-Seul Kim1, Kyung-Ran Kim1, Ji-Man Kang1, Jong-Min Kim2, Yae-Jean Kim1
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Pediatrics, Myoungji Hospital, Seonam University College of Medicine, Goyang, Korea
Corresponding Author: Yae-Jean Kim ,Tel: +82-2-3410-3539, Fax: +82-2-3410-0043, Email: yaejeankim@skku.edu
Copyright © 2017 by The Korean Pediatric Society
ABSTRACT
Purpose: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories.
Methods: Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of 38.0C for longer than 14 days and failure to reach a diagnosis after one week of investigations were included.
Results: Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%).
Conclusion: Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.
Keywords: Child | Fever of unknown origin | Infection
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