Fever of unknown origin (FUO) due to large B-cell lymphoma: The diagnostic significance of highly elevated alkaline phosphatase and serum ferritin levels

Burke A. Cunha, Andrew Petelin

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Determining the cause of fever of unknown origin (FUO) is often a vexing and difficult diagnostic process. In most cases, the signs and symptoms in adult FUOs suggest a malignant, infectious, or rheumatic/inflammatory etiology. The diagnosis of FUO may be narrowed if specific findings are present (eg, hepatosplenomegaly) that limit the diagnostic possibilities. Infectious causes of FUO with hepatosplenomegaly include miliary tuberculosis, typhoid fever, and visceral leishmanosis (kala-azar). However, FUOs with hepatosplenomegaly are most often attributable to malignant neoplasms, ie, Hodgkin lymphoma, non-Hodgkin lymphoma, hepatoma, hypernephroma (renal-cell carcinoma), or preleukemia. Methods and Results: We present a middle-aged woman with FUO and hepatosplenomegaly. Inpatient nonspecific laboratory findings included a highly elevated erythrocyte sedimentation rate, and elevated levels of vitamin B12, lactate dehydrogenase, angiotensin-converting enzyme, ferritin, and alkaline phosphatase. These individual findings are nonspecific, but together point to a lymphoma. An important test in differentiating malignant from infectious FUOs is the Naprosyn test, and her Naprosyn test was positive, indicating malignancy. A gallium scan suggested a uterine lymphoma. A computed tomography scan revealed hepatosplenomegaly, but the gallium uptake was not increased in her liver and spleen. Uterine and bone marrow biopsies were negative for lymphoma. Conclusion: We present a case of FUO with hepatosplenomegaly attributable to large B-cell lymphoma as diagnosed via liver biopsy.

Original languageEnglish
Pages (from-to)67-71
Number of pages5
JournalHeart and Lung: Journal of Acute and Critical Care
Volume42
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Keywords

  • Elevated B level
  • Elevated ESR
  • Elevated LDH
  • FUO with hepatosplenomegaly
  • Falsely elevated ACE levels in lymphoma
  • Falsely elevated PCT levels
  • Liver biopsy for FUO
  • Naprosen test in FUOs

Fingerprint

Dive into the research topics of 'Fever of unknown origin (FUO) due to large B-cell lymphoma: The diagnostic significance of highly elevated alkaline phosphatase and serum ferritin levels'. Together they form a unique fingerprint.

Cite this