Clinical Case Database / Category: Patient Management

Pyrexia of unknown origin

Publication details

J Hatcher, M Noursadeghi, J Aberdein
Foundation Years Journal, volume 3, issue 1, p.14 (123Doc Education, London, February 2009)


We present a case of a 30-year-old German student who was admitted with persistent fever, weight loss, joint pains and headache. She was originally referred for an oncology opinion by her GP, who was suspicious of an underlying haematological malignancy. She complained of 3-months intermittent fever, night sweats, fatigue and approximately 4kg weight loss. A rash had developed on her lower limbs and she described poorly localised abdominal pain, together with joint pains in her hands, feet and knees. In addition, she reported episodes of severe headache that resolved spontaneously. She had a past history of vitiligo with no significant family history. She took no regular medications, had no allergies, did not smoke and reported minimal alcohol intake. She was not sexually active and had no other risk factors for HIV infection. She had spent 6-months working as an anthropologist in West Africa in 2006. On examination her temperature was 38.0 and she looked comfortable. She was pale with a diffuse petechial rash affecting both her lower limbs. Her spleen was palpable 2 fingerbreadths below the costal margin. Joint examination was unremarkable. General physical examination was otherwise normal.

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J Hatcher

Infectious Diseases and Hospital for Tropical Diseases
University College London Hospitals NHS Foundation Trust

M Noursadeghi

Infectious Diseases and Hospital for Tropical Diseases
University College London Hospitals NHS Foundation Trust

J Aberdein

Infectious Diseases and Hospital for Tropical Diseases
University College London Hospitals NHS Foundation Trust


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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