Pyrexia of unknown origin: causes, investigation and management

Pyrexia of unknown origin (PUO) is a syndrome that has long tested the skills of physicians to achieve a diagnosis in affected patients. By definition, patients included in this syndrome will be more difficult to diagnose as they have already resisted classification during baseline investigations. Furthermore, investigation of PUO requires knowledge of many diseases across a range of clinical specialties, as well as knowledge of less commonly used investigative tools. As both society and medicine continue to change, the aetiology and epidemiology of the diseases that cause PUO also change. For these reasons, it is important for physicians to approach PUO in a logical manner, and for the causes and approach to PUO to be continuously reviewed. In this article, we review the aetiology of PUO and the diagnostic strategies that may be used to investigate it.