慢性透析患者における不明熱の診断ならびに治療

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  • Fever of unknown origin in patients undergoing maintenance hemodialysis

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From 1971 to 1983, 28 patients undergoing maintenance hemodialysis were diagnosed as having fever of unkonwn origin (FUO). Causes of FUO in these patients were infection (20 cases), drugs (2 cases), collagen disease (1 case), and unknown (5). No neoplastic disease was found as a cause of FUO. Of the infectious diseases, tuberculosis was the most common (13 out of the total 28 patients, or 46 parcent) and the incidence of extrapulmonary tuberculosis was high (11 out of 13). Urinary tract infection occurred in 3 patients. There was 1 case of infections complication of vascular-access (artificial vessels).<br>The type of fever was intermittent or remittent. The average maximum temperature was 39°C. The temperature tended to rise especially during or after hemodialysis.<br>It was possible to establish the final diagnosis in most of the patients with nontuberculous disease, but only 3 cases of tuberculosis were diagnosed definitely by the presence of bacteriologic or histologic proof during life. Five patients were diagnosed as having tuberculosis by virtue of a clear clinical response to antituberculous therapy. CT scan and ultrasonography of the abdomen revealed enlargement of the para-aortic lymph nodes in 3 of these 5 patients. These fidings disappeared with clinical improvement. CT scan and ultrasonography of the abdomen were useful diagnostic methods, especially for extrapulmonary tuberculosis.<br>Overall mortality of the group was 21 percent (6 out of 28) and 5 of the 6 patients who died had tuberculosis. Three of these 5 patients were not given antituberculosis therapy, 1 had miliary tuberculosis and in the remaining patient the timing of initiation of antituberculous therapy was inappropriate. Four tuberculosis patients died within 2 months after the onset of symptoms.<br>A trial of antituberculosis therapy is warranted in patients undergoing maintenance hemodialysis in whom FUO develops.

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