Ostermayer: Created page with "====Infections (~40-60%, most common cause in children)==== *'''Bacterial''' UTI/pyelonephritis (especially in infants and young children) Occult abscess (intra-abdominal, hepatic, pelvic, perinephric, retropharyngeal, dental) Osteomyelitis Endocarditis Cat scratch disease (''Bartonella henselae'') — one of the most common causes of pediatric FUO Brucellosis (exposure to unpasteurized dairy, travel) **Tuberculosis (pulmonary..."

2026-03-09T19:30:08Z

Created page with "====Infections (~40-60%, most common cause in children)==== *'''Bacterial''' **UTI/pyelonephritis (especially in infants and young children) **Occult abscess (intra-abdominal, hepatic, pelvic, perinephric, retropharyngeal, dental) **Osteomyelitis **Endocarditis **Cat scratch disease (''Bartonella henselae'') — one of the most common causes of pediatric FUO **Brucellosis (exposure to unpasteurized dairy, travel) **Tuberculosis (pulmonary..."

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====Infections (~40-60%, most common cause in children)====
*'''Bacterial'''
**[[UTI]]/[[pyelonephritis]] (especially in infants and young children)
**Occult [[abscess]] (intra-abdominal, hepatic, pelvic, perinephric, retropharyngeal, dental)
**[[Osteomyelitis]]
**[[Endocarditis]]
**[[Cat scratch disease]] (''Bartonella henselae'') — one of the most common causes of pediatric FUO
**[[Brucellosis]] (exposure to unpasteurized dairy, travel)
**[[Tuberculosis]] (pulmonary and extrapulmonary, especially miliary)
**[[Sinusitis]] (chronic/occult)
**[[Mastoiditis]]
**[[Lyme disease]]
**[[Q fever]]
**[[Rat-bite fever]]
**[[Salmonella]] (enteric fever/typhoid)
**[[Tularemia]]
**[[Leptospirosis]]
*'''Viral'''
**[[EBV]] (mononucleosis)
**[[CMV]]
**[[HIV]] (acute seroconversion or perinatal)
**[[Hepatitis A]], [[hepatitis B]]
**[[Adenovirus]]
**[[COVID-19]]
**[[Parvovirus B19]]
*'''Fungal'''
**[[Histoplasmosis]]
**[[Coccidioidomycosis]]
**[[Blastomycosis]]
**[[Cryptococcosis]] (immunocompromised)
**[[Aspergillosis]] (immunocompromised)
*'''Parasitic'''
**[[Malaria]] (travel history)
**[[Toxoplasmosis]]
**Visceral leishmaniasis
**Toxocara (visceral larva migrans)

====Autoimmune/Inflammatory (~10-20%)====
*'''Rheumatic'''
**[[Systemic JIA]] (sJIA / Still's disease) — '''most common rheumatic cause of FUO in children'''
**[[Systemic lupus erythematosus]] (SLE) — more common in adolescents
**Juvenile dermatomyositis
**[[Polyarteritis nodosa]]
**[[Reactive arthritis]]
*'''Vasculitis'''
**[[Kawasaki disease]] — '''important to consider in any child <5 years with prolonged fever'''; may be "incomplete Kawasaki" without classic features
**[[Henoch-Schönlein purpura]] (IgA vasculitis)
**Takayasu arteritis (rare in children)
*'''Inflammatory'''
**[[Inflammatory bowel disease]] (Crohn's disease > ulcerative colitis; may present with fever and weight loss before GI symptoms)
**[[Sarcoidosis]] (rare in young children)
*'''Autoinflammatory/Periodic Fever Syndromes'''
**PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, adenitis) — '''most common periodic fever syndrome in children; benign'''
**[[Familial Mediterranean fever]] (FMF)
**TNF receptor-associated periodic syndrome (TRAPS)
**Hyper-IgD syndrome (HIDS/mevalonate kinase deficiency)
**Cryopyrin-associated periodic syndromes (CAPS)
**Chronic recurrent multifocal osteomyelitis (CRMO)
*'''Hemophagocytic'''
**[[Macrophage activation syndrome]] (MAS) — especially complicating sJIA
**[[Hemophagocytic lymphohistiocytosis]] (HLH) — primary (familial) or secondary

====Malignancy (~5-10%)====
*'''Hematologic''' (most common malignant cause of FUO in children)
**[[Leukemia]] (ALL most common, AML) — '''most important malignancy to exclude'''
**[[Lymphoma]] (Hodgkin > non-Hodgkin in older children/adolescents)
**Langerhans cell histiocytosis
*'''Solid Tumors'''
**[[Neuroblastoma]] (especially in children <5 years)
**Wilms tumor
**Ewing sarcoma / osteosarcoma (with bone involvement)
**Hepatoblastoma

====Drug Fever====
*[[Antibiotics]] (beta-lactams, sulfonamides)
*[[Anticonvulsants]] (phenytoin, carbamazepine, lamotrigine)
*[[Atropine]], anticholinergics
*[[DRESS syndrome]]
*Chemotherapy agents
*Immunizations (post-vaccination fever — usually self-limited and brief)

====Central/Neurogenic Fever====
*[[Hypothalamic dysfunction]] (tumor, trauma, surgery, hemorrhage)
*Autonomic dysreflexia (spinal cord injury)
*Post-neurosurgical

====Factitious/Fabricated====
*Fabricated or induced illness (Munchausen syndrome by proxy / medical child abuse) — '''consider when fever is documented only by caregiver, pattern is atypical, and no objective cause is identified'''
*Self-induced (older children/adolescents)

====Miscellaneous====
*[[Hemolytic anemia]] (sickle cell crisis, autoimmune hemolytic anemia)
*Hematoma resorption (after trauma)
*[[Ectodermal dysplasia]] (anhidrotic — impaired heat regulation, not true fever)
*Thyrotoxicosis (rare in children)
*[[Diabetes insipidus]] (dehydration-related hyperthermia)
*Infantile cortical hyperostosis (Caffey disease)
*Castleman disease (rare)
*Chronic granulomatous disease (recurrent infections)
*Cyclic neutropenia
*Idiopathic (~10-20% of pediatric FUO remains undiagnosed; most self-resolve)

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