This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (10)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Elisabeth M. H. A. de Kleijn, MD; Wim J. G. Oyen, MD; Roland A. M. J. Claessens, MD, PhD; Frans H. M. Corstens, MD; Jos W. M. van der Meer, MD

Arch Intern Med. 1995;155(18):1989-1994.

Abstract
Background
We assessed the utility of scintigraphy with indium 111—labeled polyclonal human IgG scintigraphy in patients with fever of unknown origin that fulfilled the criteria of temperature of 38.3°C or more for at least 3 weeks and no diagnosis during 1 week of hospital admission. We compared the utility of this technique with results of scintigraphic techniques reported in the literature.

Methods
Data for all patients seen at our university hospital in whom¹¹¹In-IgG scanning was performed were analyzed and checked for the criteria for fever of unknown origin. The literature on the utility of scintigraphic techniques in patients with fever of unknown origin was reviewed.

Results
We studied 24 patients with fever of unknown origin. In 13 patients, focal¹¹¹In-IgG accumulation was observed. In nine (38%) of those, the positive¹¹¹ In-IgG scintigram led to the final diagnosis; in the other four patients (17%), the scintigraphic findings were not helpful. In the 11 patients with negative¹¹¹In-IgG scans, extensive diagnostic workup produced no infection as the final diagnosis in nine patients (38%), one had an abscess in a renal cyst that was detected several months later, and in the other the cause of fever was an infected intravenous line. The overall sensitivity and specificity of¹¹¹In-IgG scintigraphy were 81% and 69%, respectively. The positive predictive value was 69% and the negative predictive value was 82%.

Conclusions
Our results show that¹¹¹In-IgG scintigraphy significantly contributed to the diagnostic process in patients with fever of unknown origin. A positive scan increased the likelihood of finding the cause of the fever, and a negative scan ruled out an inflammatory component with a high degree of certainty. These data compare favorably with data in the literature concerning other radiopharmaceuticals; a larger prospective evaluation of this technique is indicated.

(Arch Intern Med. 1995;155:1989-1994)

Author Affiliations
From the Departments of Medicine (Drs de Kleijn and van der Meer) and Nuclear Medicine (Drs Oyen, Claessens, and Corstens), University Hospital Nijmegen (the Netherlands).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Comprehensive Evidence-Based Approach to Fever of Unknown Origin
Mourad et al.
Arch Intern Med 2003;163:545-551.
ABSTRACT | FULL TEXT