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Lymphoma Causing FUO — RACP Adult Medicine MCQ

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ModerateHaematologyLymphoma Causing FUORACP Adult Medicine

A 45-year-old man presents with FUO (fever >38.3°C for >3 weeks without diagnosis after 1 week of investigation). He has night sweats, weight loss 8 kg, and elevated LDH. CT shows retroperitoneal and mesenteric lymphadenopathy. PET-CT shows intensely FDG-avid nodes. Lymph node biopsy shows DLBCL. What is the most likely cause of FUO?

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Correct answer: B — Lymphoma

Lymphoma (especially NHL/DLBCL) is one of the most common neoplastic causes of FUO. B symptoms (fever, night sweats, weight loss), elevated LDH, and FDG-avid lymphadenopathy on PET-CT with biopsy-confirmed DLBCL. PET-CT has become an important tool in FUO investigation. The classic FUO categories: infection (~30%), malignancy (~20%), autoimmune/inflammatory (~15%), miscellaneous (~15%), and undiagnosed (~20%).

Reference: eTG Infectious Diseases – 2024 – FUO; Petersdorf 2024 Review