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In reply

Fever of unknown origin or, as I put it, "prolonged FUO (3 weeks)"¹ remains valuable as an operational definition for an unusual yet important and time-consuming clinical problem. Properly understood, it implies both intellectual honesty and an ongoing commitment to the patient. Dr Chang's proposed alternative, "fever of unidentified disease," is inaccurate because fever, a physiologic response, does not always denote disease. It may, however, comfort Dr Chang to know that I have long maintained and taught that frequent use of the modifier cause undetermined (eg, "headache, cause undetermined [suspected migraine variant]") is the mark of the careful and diligent physician.

Charles S. Bryan, MD
Columbia, SC

1. Bryan CS. Fever of unknown origin: the evolving definition. Arch Intern Med. 2003;163:1003-1004. FREE FULL TEXT

Arch Intern Med. 2003;163:2103.

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