Fever of unknown origin: a clinical mask of malignant peritoneal mesothelioma

Our plain-English summary of Fever of unknown origin: a clinical mask of malignant peritoneal mesothelioma, by J. Hermann, G. Bajko, M. Stajgis, et al (Contemporary Oncology = Współczesna Onkologia, 2012).

The study

• Authors: J. Hermann, G. Bajko, M. Stajgis, J. Szmeja, T. Kościński, M. Drews
• Journal: Contemporary Oncology = Współczesna Onkologia
• Published: 2012;16(6):596-9
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The authors present a patient suffering from malignant peritoneal mesothelioma. Differential diagnosis has become the major concern in the fatally ill patient. Pain, increasing abdominal girth, anorexia and weight loss, and recurrent ascites are the most frequent presenting symptoms. In this patient, fever of unknown origin was a clinical mask of mesothelioma. The diagnostic process was focused on infections and collagen-vascular diseases since they are the most common causes of the systemic inflammatory response syndrome. However, persistent pyrexia can also occur, less frequently, in the course of any malignant disease.

In plain English

This case report from Poznań, Poland, described one 50-year-old man with malignant peritoneal mesothelioma whose illness first appeared as fever of unknown origin. He fell ill in late May 2009 with fever, sore throat and muscle aches. Doctors treated him for infections and suspected sarcoidosis, bronchitis and diverticulitis while his inflammation markers rose. A June 2009 abdominal CT scan was read as inflammation. An independent radiologist later saw a mass about 16 cm across. Surgery in August 2009 found an unresectable mass filling the abdomen, and tissue tests confirmed epithelial-type malignant mesothelioma. Despite treatment he died on 14 September 2009. After his death, his wife reported that he had lived near an asbestos factory until age 14 and that the local road and his courtyard were hardened with asbestos. No fiber type was given. The authors concluded that the disease appeared under the mask of fever of unknown origin, and that the differing CT readings showed how hard such abdominal lesions are to judge.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 50-year-old man in Poznań, Poland, who fell ill at the end of May 2009
• Exposure: Reported by his wife after his death: he lived near an asbestos factory until age 14, and the local road and his courtyard were hardened with asbestos. No fiber type, dose or occupational exposure is given.
• Main results:
  • Early tests in the patient were negative except for raised erythrocyte sedimentation rate (95 mm/h) and C reactive protein (46 mg/l). These later rose to an ESR of 120 mm/h and a CRP of 103.5 mg/l.
  • After the abdominal CT, the consultant surgeon suspected diverticulitis, and the patient was treated with intravenous metronidazole.
  • By admission to surgery, the patient had fever, malaise, mild right upper abdominal pain and weight loss of about 15 kg.
  • At laparotomy, the patient's abdomen was filled with an unresectable omental mass.
  • The patient's histopathology showed either low differentiated cancer or malignant mesothelioma. Immunohistochemical staining (positive for WT1, CK5/6, CK7 and calretinin) confirmed epithelial-type malignant mesothelioma.
  • An independent radiologist, unaware of the final diagnosis, re-read the patient's June 2009 CT scans and recognized an inflammatory or neoplastic mass about 16 cm in diameter.
  • The patient died on 14.09.2009, after admission to the oncology department for chemotherapy.
• The authors' conclusion: The authors concluded that in this patient, malignant peritoneal mesothelioma presented clinically as fever of unknown origin. They also concluded that the discrepancy between the two CT readings shows the difficulty of radiological evaluation of peritoneal lesions.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Differential Diagnosis, Ascites, Mesothelioma, Collagen.

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