DIFFICULTIES AND MISTAKES IN THE DIAGNOSIS OF THE ROOT CAUSES OF FEVER OF UNKNOWN GENESIS (CLINICAL CASE)

A clinical case of fever of unknown origin in a 80-year-old patient who was treated in the hospital (thoracic, surgical, therapeutic department) for 4 months with a diagnosis of fever of unknown genesis. Chronic obstructive pulmonary disease Stage 3, exacerbation. Bullous emphysema. Chronic pulmonary heart decompensation. Respiratory failure II. Coronary heart disease. Postinfarction cardiosclerosis without further elaboration. Arterial hypertension, stage III, risk 4 (very high). Aortic heart disease: stenosis and insufficiency. Chronic heart failure IIA FC III. Cholelithiasis. Chronic calculous cholecystitis. Benign prostatic hyperplasia. Chronic cystitis. Chronic pyelonephritis. Chronic kidney disease. Stage Glomerular filtration 25 ml/min/1,73 m2. Anemia is severe, and died with symptoms of increasing multiorgan failure is considered. The errors of the lifetime diagnosis of systemic vasculitis, in particular Wegener's granulomatosis, are analyzed. The importance of an expanded definition of antineutrophilic cytoplasmic antibodies (ANCA) is emphasized, in particular, to proteinase-3. It was noted that a biopsy in a patient with a fever of unknown genesis and multiorgan lesions, as well as an extended study of the spectrum of the ANCA, could be a decisive factor in the lifetime diagnosis of Wegener’s granulomatosis. It is concluded that a negative result on ANCA to myeloperoxidase should not stop further diagnostic search.