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Fever of unknown origin (FUO) is still a diagnostic challenge for the family physician and the internist. In the last decades a few reports have emphasized a changing pattern in the prevalence of the 3 main categories of FUO: infections, malignancies and collagen diseases.a. to find out if the changing pattern among the main diagnoses in patients with FUO is comparable to previous reports.Medical files of patients that were admitted in two 450 beds rural Israeli hospitals were checked by two physicians. All files of patients with either the diagnosis of FUO, or files of patients with fever that were hospitalized for a week or longer in internal medicine departments were reviewed.101 files of patients fulfilling the criteria of FUO were found. Surprisingly 54.5% of them had infectious diseases, 7.9% had malignant disease and only 2% had collagen disease.a. Infectious diseases are still the leading cause of FUO among Israeli patients. b. The prevalence of infectious and malignant diseases is comparable to other studies, however the low rate of connective tissue diseases in our study is unusual. c. The rate of undiagnosed FUO was remarkably high (32.7%), although all these patients recovered during hospitalization and probably had self limited infectious (viral) disease.

The prevalence of hepatitis C virus (HCV)-RNA positivity among hemodialysis patients varies between 10 and 70%. Few previous surveys revealed high frequency of seroconversion of HCV-RNA-negative patients over the years of hemodialysis. Only few studies reported HCV genotype variability. We evaluated all 65 patients on chronic hemodialysis in our dialysis unit. All sera positive to anti-HCV on ELISA were retested by reverse transcriptase polymerase chain reaction to HCV-RNA. Sixteen patients were found anti-HCV positive on ELISA, and 8 of them were also PCR positive. Three of these eight patients seroconverted during the year 1995. Four patients had both 1a and 1b genotypes of HCV, coexistence of genotypes 1b and 4a in one patient and genotypes 1a, 1b and 2a in the remaining three patients. Mean serum aminotransferase, duration of dialysis, and number of blood units transfused were significantly higher in the HCV-PCR-positive patients compared with the HCV-PCR-negative patients. Because strict isolation methods were initiated at the end of 1995, not one new case of HCV among dialysis patients was found in 1998, although new hemodialysis patients were diagnosed as having HCV. In conclusion, genotypes 1a and 1b, as is true for the general population in Israel, were also the predominant genotypes among hemodialysis patients; the coexistence of more than one genotype is common among hemodialysis patients; seroconversion is common among these patients and strict isolation methods are efficient and should be recommended.

A 23-year-old woman was admitted with a history of 2 weeks of cough, fever and bilateral lung infiltrates. She had been diagnosed 2 months before as having ulcerative proctitis and was treated with mesalamine, which induced a full remission, but 3 antibiotic regimens failed to improve her lung disease. Since computerized tomography revealed bilateral peripheral lung infiltrates and her eosinophile count was elevated, the diagnosis of drug-induced eosinophilic pneumonia was suggested. Mesalamine and antibiotics were stopped and oral corticosteroids begun. She became almost asymptomatic a week after mesalamine withdrawal, and the x-ray became normal.