Sarcoma presenting as fever of unknown origin: a case report
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Fever of unknown origin is often a diagnostic dilemma for clinicians due to its extremely broad differential. One of the rarer categories of disease-causing fever of unknown origin is malignancies; of these, soft tissue sarcoma is one of the least common.

The present case has been reported in the Journal of Medical Case Reports. A 73-year-old woman presented with a 2-week history of fever and profound fatigue. The only other symptom she endorsed was a transient history of left knee pain, initially thought to be unrelated. There was no clear cause on initial examination and routine investigations, but her

C-reactive protein was significantly elevated at 207 mg/L. Blood cultures and a urine culture were drawn. She was admitted to hospital for further investigation and placed on empiric antibiotics. Her blood cultures were negative, but she had one further fever in hospital. Computed tomography scans did not yield a cause of her fever. No vegetations were seen on echocardiography.

Antibiotics were stopped as she did not seem to have an acute infectious cause of her fever. No new symptoms developed. She felt well enough to proceed with out-patient follow up and was discharged after 8 days in hospital. At 1-month post-discharge: no resolution of symptoms, but she endorsed a recurrence of her left knee pain.

Ultrasound and magnetic resonance imaging revealed a 4.5 × 6.8 × 11.6 cm soft tissue mass, identified as a sarcoma on biopsy. She subsequently underwent a distal femur resection. Final staging was pT2bN0M0. She underwent adjuvant radiation therapy, but was found to have developed metastatic disease.

Key points:-
- Fever of unknown origin (FUO) commonly presents with atypical manifestations of the underlying cause. In these scenarios, no symptom should be deemed insignificant.

- Repeated examinations over time are often needed to elucidate the cause of FUO.

- FUO is an uncommon presentation for sarcoma but can occur.

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