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Fever of Unknown Origin Caused by Multiple Myeloma
A Report of 9 Cases
Paul S. Mueller, MD;
Christine L. Terrell, MD;
Morie A. Gertz, MD
Arch Intern Med. 2002;162:1305-1309.
Background Most authorities regard multiple myeloma as a rare cause of fever and
not a cause of fever of unknown origin (FUO).
Objective To describe a series of patients with FUO caused by multiple myeloma.
Methods We reviewed the clinical features of 9 patients seen at Mayo Clinic
from January 1, 1975, to February 1, 2001, with FUO caused by multiple myeloma.
Results Fever of unknown origin caused by multiple myeloma was found in 9 patients
(6 men and 3 women). All patients satisfied accepted criteria for FUO. The
mean ± SD time from the onset of fevers to the initial physician evaluation
was 4.8 ± 2.0 weeks. The mean time from the initial physician evaluation
to the diagnosis of multiple myeloma was 11.4 ± 6.5 weeks. The mean
age at diagnosis of multiple myeloma was 55.9 ± 6.9 years. All 9 patients
were anemic. Peripheral blood smears were available for 8 patients, and all
had rouleaux formations. All 9 patients underwent exhaustive testing to determine
the cause of fevers. Further testing was done in 6 patients subsequent to
the diagnosis of multiple myeloma. Acetaminophen or nonsteroidal anti-inflammatory
drugs or both relieved fevers in all patients who received them. All 8 patients
who received chemotherapy experienced resolution of fevers. The median actuarial
survival of the patient cohort was 38 months.
Conclusions Multiple myeloma can cause FUO. When appropriate, clinicians should
include multiple myeloma in the differential diagnosis of FUO to reduce unnecessary
testing, rapidly establish the diagnosis, and initiate effective treatments.
From the Divisions of General Internal Medicine (Dr Mueller), Infectious
Diseases and Internal Medicine (Dr Terrell), and Hematology and Internal Medicine
(Dr Gertz), Mayo Clinic, Rochester, Minn.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Multiple myeloma in a patient with fever of unknown origin and cholestasis
Mumoli et al.
CMAJ 2004;170:1809-1810.
ABSTRACT
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