Table 2.

Physical Findings and Associated Fever of Unknown Origin Diagnoses (31)

SystemFindingAssociated Illness
Abdomen
HepatomegalyLymphoma, metastatic carcinoma, relapsing fever, granulomatous hepatitis, hemophagocytic lymphohistiocytosis, Q fever, typhoid fever, viral infections, salmonellosis, brucellosis, bartonellosis, endocarditis, malaria, leukemia
Liver edge tendernessBartonellosis, liver abscess
Splenic abscessInfective endocarditis, brucellosis, enteric fever
SplenomegalyLeukemia, lymphoma, tuberculosis, brucellosis, infective endocarditis, cytomegalovirus, hemophagocytic lymphohistiocytosis, Epstein-Barr virus, psittacosis, relapsing fever, typhoid fever, Rocky Mountain spotted fever, Kikuchi-Fuijmoto disease
Chest
MurmurInfective endocarditis, atrial myxoma
Relative bradycardiaTyphoid fever, malaria, leptospirosis, psittacosis, central fever, drug fever
Eyes
Abnormal funduscopic examination findingsMiliary tuberculosis, toxoplasmosis, vasculitis
Conjunctival suffusionLeptospirosis, relapsing fever, Rocky Mountain spotted fever
ConjunctivitisEpstein-Barr virus, Newcastle disease, leptospirosis, Kawasaki disease (limbic sparing), tuberculosis, systemic lupus erythematosus, bartonellosis, chlamydial infection, histoplasmosis, tumor necrosis factor receptor-associated periodic syndrome, familial cold autoinflammatory syndrome
Decreased pupillary constrictionHypothalamic or autonomic dysfunction
Dry eyesFamilial dysautonomia, systemic lupus erythematosus, polyarteritis nodosa, Sjögren syndrome
Ischemic retinopathyPolyarteritis nodosa
Periorbital edemaTumor necrosis factor receptor-associated periodic syndrome
Subconjunctival hemorrhageEndocarditis, trichinosis
Uveal tract involvementTuberculosis, juvenile idiopathic arthritis, toxoplasmosis, sarcoidosis, systemic lupus erythematosus
Lymph Nodes
LymphadenopathyLymphoma, bartonellosis, tuberculosis, lymphogranuloma venereum, cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus, toxoplasmosis, juvenile idiopathic arthritis, brucellosis, Kikuchi-Fuijmoto disease, tularemia, viral infections, mycobacterial infection, leukemia, hyperimmunoglobulin D syndrome, familial cold autoinflammatory syndrome
Genitourinary
Epididymo-orchitisTuberculosis, lymphoma, brucellosis, leptospirosis, Epstein-Barr virus, blastomycosis, carcinoma
Musculoskeletal
Bone tendernessOsteomyelitis, malignancy, infantile cortical hyperostosis
Costovertebral tendernessChronic pyelonephritis, perinephric abscess
Hyperactive reflexesHyperthyroidism
Hypoactive reflexesFamilial dysautonomia
Joint tendernessFamilial Mediterranean fever, rat-bite fever, systemic lupus erythematosus, Lyme disease, lymphogranuloma venereum, brucellosis, hyperimmunoglobulinemia D syndrome, tumor necrosis factor receptor-associated periodic syndrome
Muscle tendernessBrucellosis, trichinellosis, arboviral infection, dermatomyositis, polyarteritis, subdiaphragmatic abscess (trapezius tenderness)
Spinal tendernessSubacute vertebral osteomyelitis, infective endocarditis, brucellosis, typhoid fever
Oropharynx
Anomalous dentitionAnhidrotic ectodermal dysplasia
Dental or fascial abscessSinusitis, brain abscess, mediastinal abscess
EpistaxisRelapsing fever, leukemia, psittacosis, rheumatic fever
Gingival hypertrophyLeukemia, Langerhans cell histiocytosis
Pharyngeal hyperemiaCytomegalovirus, Epstein-Barr virus, toxoplasmosis, tularemia, leptospirosis
Smooth tongueFamilial dysautonomia
UlcerationsBehçet disease; periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA); hyperimmunoglobulin D syndrome
Skin (limited review)
Blotchy skinFamilial dysautonomia
Decreased body hair, hypohidrosisAnhidrotic ectodermal dysplasia
DehydrationDiabetes insipidus, ectodermal dysplasia, familial dysautonomia
Erythema nodosumInfection, juvenile idiopathic arthritis, systemic lupus erythematosus, malignancy, inflammatory bowel disease
Erythema migransLyme disease, southern tick-associated rash illness (STARI)
EscharTularemia
Macular salmon-pink rashJuvenile idiopathic arthritis
Malar erythemaSystemic lupus erythematosus
Palpable purpuric lesionsPolyarteritis nodosa
PetechiaeEndocarditis, bacteremia, viral infection, rickettsia
Seborrheic rashHistiocytosis
Urticarial macular rashSerum sickness, familial cold autoinflammatory syndrome, Muckle-Wells syndrome, neonatal-onset multisystem inflammatory disease