Moffitt report PEARLS: FUO, miliary pulmonary nodules, steroids for TB?

 

  1. FUO: rule of 3s: >3 outpatient visits or 3d in hospital with unrevealing w/u, and duration >3 wks
    1. Always important to break this down even further as this changes your differential! classic, nosocomial, immune deficient, or HIV-associated
    2. Here’s a great review: http://www.ncbi.nlm.nih.gov/pubmed/22475734
  2. Miliary pulmonary nodules ddx:
    1. Miliary TB, fungal infection (disseminated cocci, histo), also sarcoid, nocardia, pneumoconiosis (silicosis), varicella pneumonia, malignancy
  3. Steroids in disseminated TB?
    1. Typically used in TB pericarditis or meningitis to prevent complications such as constrictive pericarditis, hydrocephalus, focal neurologic deficits. Consider in TB-related ARDS.
    2. Check out this 2010 review article if you are curious for more! http://www.ncbi.nlm.nih.gov/pubmed/20949734
  4. Bonus pearl: When to test for immunodeficiency:check out the slide below from a rheum grand rounds earlier this month! While testing for this particular patient is not on the list, given his young age and disseminated infection, might also consider immunodeficiency testing.

When to test for immunodeficiency

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