What’s Wrong With Me?
A medical mystery resolved. LISA BENDALL
MARIA WAS exhausted and hadn’t been able to work in weeks. In March 2018, the social worker had developed a mysterious fever that came and went, and her lower abdomen burned with pain. Her family doctor prescribed antibiotics for a suspected urinary tract infection, to no effect. In the night, she would wake up so drenched in sweat she’d have to change all her bedding.
By mid-April, Maria had lost more than three kilograms and, around that time, experienced two episodes of an intense, stabbing chest pain that made her fear for her life.
A chest X-ray and abdominal ultrasound came back normal, but after a lab test found Maria’s C-reactive protein count to be high—indicating inflammation somewhere in her body—she was referred to Geneva University Hospitals.
A fever of unknown origin—or FUO—is one of the most onerous diagnostic challenges, says Dr. JeanLuc Reny. By definition, it’s a persistent fever lasting more than three weeks that can’t be explained after a full in-hospital workup. “Solving it is like running a marathon. It’s a matter of training and patience.”
There are over 200 potential causes of an FUO, the most common being infection, inflammatory disease and malignancy. Many cases are never solved, and a small fraction of
THE PATIENT: Maria*, a 61-year-old social worker
THE SYMPTOMS: Fever and lower abdominal pain
THE DOCTOR: Dr. Jean-Luc Reny, head of the Division of General Internal Medicine, Geneva University Hospitals, Switzerland
*Biographical details have been changed.