Fever of unknown origin. Assessment of the value of percutaneous liver biopsy

Abstract

This study was done to assess the value of percutaneous liver biopsy in the diagnosis of fever of unknown origin (FUO). A retrospective analysis was performed on all cases (43) seen at Vanderbilt University Hospital [USA] in the last 12 yr in which a percutaneous liver biopsy was performed in the course of the evaluation or presence of FUO. The 43 patients who underwent biopsy were assigned to 3 arbitrary groups: group 1, liver biopsy abnormal and helpful in diagnosis and often in therapy; group 2, liver biopsy abnormal but of no definite diagnostic and therapeutic value; group 3, liver biopsy normal or essentially normal. Distribution of the 43 patients in these categories was as follows: group 1, 6 individuals (13.9%); group 2, 11 patients (25.6%), and group 3, 26 patients (60.5%). Group 1 patients had hepatomegaly 3 times as often (P < .05) and abnormal liver function tests 25% more commonly (P > .05) the the other 2 combined groups, but the overlap was substantial in both parameters. Percutaneous liver biopsy may be helpful in a positive manner in the diagnosis of FUO but only in a very small number of cases. A surprisingly large number of patients with FUO are undiagnosed, but the overall prognosis is relatively good. In view of newly available diagnostic techniques and the small fraction of all cases of FUO that undergo biopsy, a prospective evaluation of the role of percutaneous liver biopsy in the diagnosis of FUO using a larger number of cases is warranted.