Malignancy in Chinese adults presenting as fever of unknown origin

It is difficult to make a diagnosis when malignancy presents as fever of unknown origin (FUO). In order to update information on this disease entity, we performed a retrospective survey on adult cancer patients (n=48) presenting with FUO who were admitted to our university hospital between 1989 and 2002. All 48 patients had a median fever course of 56 days and a diagnostic phase of 13 days. Anaemia was found in 89.6% of the patients and elevated ESR in 77.1%. Of 35 patients (72.9%) with haematological malignancy, most were either lymphoma (n=18) or malignant histiocytosis (n=13). Solid tumours were found in 13 patients (27.1%), of which seven were hepatic carcinoma. Only five patients were correctly diagnosed, and 39 (90.7%) were mistaken for various infections. Inconclusive signs and symptoms, misinterpretation of test results and improper use of broad-spectrum antibiotics and corticosteroids all contributed to the misdiagnoses.