Abstract
Background: Diagnosis of fever of unidentified cause remains challenging despite the availability of modern diagnostic techniques. Pyrexia of Unknown Origin (PUO) may result from various etiologies, among which infectious diseases are largely responsible. Many diagnostic approaches are currently applied. A detailed history with a complete general physical examination followed by baseline investigations with other specific tests like imaging, microbiological tests, and biopsies is employed to diagnose PUO. This study was designed for the evaluation and effectiveness of bone marrow biopsy in the identification of PUO and highlighted the existing spectrum of diseases involved in PUO.
 Methodology: This Cross-sectional study was conducted at Dow University of Health Sciences, Karachi from 2015 to 2018 evaluated the records of patients who had bone marrow aspiration and biopsy Patients included in this study had a history of fever due to an Unfamiliar cause and met the Peters Dorf and Beeson criteria for PUO, i.e. fever for more than 3 weeks before diagnosis. Informed consent was taken from all patients.
 Results: We analyzed the medical histories of 67 patients (48 males and 19 females) who were recommended bone marrow biopsy and aspiration for the assessment of PUO. The mean age was 38 years. The most common clinical symptoms found in patients of PUO were fever, hepato-splenomegaly followed by abdominal pain and weight loss. Anemia was the most common hematological parameter found in this study. The most frequent diagnosis in biopsies of PUO patients was Non-Hodgkins Lymphoma in about 25% of patients.
 Conclusion: Certain laboratory and clinical parameters can detect major hematological diseases like malignancies when bone marrow biopsy is used for the workup of pyrexia of unknown origin. Bone marrow biopsy should be regarded as a constitutive part of the workup and diagnosis of pyrexia of unknown origin in conjunction with clinical findings.
Highlights
Various medical conditions are not necessarily related to each other but share the common symptom of long-standing fever unexplained after baseline tests. These conditions fall under the umbrella term of “Pyrexia of unknown origin." With advancements in diagnostic methods, treatment modalities and medical technology, the presentation of Pyrexia of Unknown Origin (PUO) and physicians’ approach for its management is evolving continuously
We analyzed the medical histories of 67 patients who were suggested for bone marrow biopsy and aspiration to assess PUO
This study indicates certain laboratory and clinical parameters that can detect major hematological diseases like malignancies when bone marrow biopsy is used to workup of pyrexia of unknown origin
Summary
Various medical conditions are not necessarily related to each other but share the common symptom of long-standing fever unexplained after baseline tests. Fever of unknown origin is associated with a diverse spectrum of diseases[5,6] such as malignancy, infections, inflammatory diseases and other miscellaneous etiologies[7] It has been shown in many studies that infections such as abscesses, endocarditis, tuberculosis, UTIs and others are frequently associated with PUO8. It has been reported in a study that bone marrow biopsy and culture and blood culture give better diagnostic outcomes in mycobacterial, fungal and HIV diseases[8]. Conclusion: Certain laboratory and clinical parameters can detect major hematological diseases like malignancies when bone marrow biopsy is used for the workup of pyrexia of unknown origin. Bone marrow biopsy should be regarded as a constitutive part of the workup and diagnosis of pyrexia of unknown origin in conjunction with clinical findings
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