Bone Marrow Biopsy in the Diagnosis of Fever of Unknown Origin in Patients With Acquired Immunodeficiency Syndrome
Natividad Benito, MD;
Antonio Núñez, MD;
Miguel de Górgolas, MD;
Jaime Esteban, MD;
Teresa Calabuig, MD;
Maria del Carmen Rivas, MD;
Manuel L. Fernández Guerrero, MD
Arch Intern Med. 1997;157(14):1577-1580.
Abstract
| |
Background
Fever is commonly observed in patients with human immunodeficiency virus (HIV) disease and frequently eludes diagnosis. The role of bone marrow biopsy in the diagnosis of fever of unknown origin in patients infected with HIV remains controversial.
Patients and Methods
One hundred twenty-three consecutive patients with 137 episodes of fever lasting 10 or more days without diagnosis after 1 week of hospitalization were evaluated by bone marrow biopsy.
Results
Overall, a specific diagnosis was achieved in 52 episodes by means of culture and histopathological examination (diagnostic yield, 37.9%). Three types of disease were found: mycobacterial infections (n=36, 69% of documented episodes), including 18 patients with disseminated tuberculosis and 14 with Mycobacterium avium-intracellulare complex infections; non-Hodgkin lymphomas (n=12, 23%); and visceral leishmaniasis (n=4, 8%). Although bone marrow cultures were more sensitive than microscopic examination with special stains for the diagnosis of mycobacterial infections, the pathological examination of bone marrow led to a more rapid diagnosis of disease. In addition, the histopathological examination of bone marrow alone led to the diagnosis of a specific condition in 43 episodes (31.3% of all episodes).
Conclusions
Bone marrow biopsy is a useful procedure for the diagnosis of fever in patients with advanced HIV disease, particularly in areas where tuberculosis and leishmaniasis are prevalent. Involvement of the marrow may be the first indication of the existence of extranodal non-Hodgkin lymphoma. For Mycobacterium avium-intracellulare complex infection, blood cultures were more sensitive than bone marrow biopsy.
Arch Intern Med. 1997;157:1577-1580
Author Affiliations
From the Division of Infectious Diseases and Hematology (Department of Medicine) and Departments of Clinical Microbiology and Pathology, Fundación Jimenez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Yield of Bone Marrow Examination in Diagnosing the Source of Fever of Unknown Origin
Hot et al.
Arch Intern Med 2009;169:2018-2023.
ABSTRACT
| FULL TEXT
Human Immunodeficiency Virus Hematology
Volberding et al.
ASH Education Book 2003;2003:294-313.
ABSTRACT
| FULL TEXT
The utility of bone-marrow examination in HIV-infected adults in South Africa
Karstaedt et al.
QJM 2001;94:101-105.
ABSTRACT
| FULL TEXT
THE VALUE OF BONE MARROW BIOPSY IN HIV+ PATIENTS WITH FEVER
JWatch General 1997;1997:1-1.
FULL TEXT
|
