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THE VALUE OF BONE MARROW BIOPSY IN HIV+ PATIENTS WITH FEVER.

Fever is a worrisome symptom in HIV-positive patients, and its cause is often elusive. This study from Spain evaluated the diagnostic yield of bone marrow biopsy in 123 HIV-positive patients (103 men, 20 women; average age, 36 years). The patients as a group had 137 episodes of fever (temperature greater than 38.5 degrees C) for at least 10 days, with origin of fever unclear after one week of hospitalization and the usual microbiologic workup.

Bone marrow biopsy (specimen culture and pathological examination) led to a specific diagnosis in 52 episodes, for a diagnostic yield of 37.9 percent. The most common diagnoses were mycobacterial infections (including 18 patients with disseminated tuberculosis and 14 with Mycobacterium avium complex infections), non-Hodgkin lymphoma, and leishmaniasis.

Comment: The value of bone marrow biopsy in HIV-positive patients with fever is still controversial; all three diagnoses noted above might be made through other means. But the procedure should at least be considered in patients whose initial workup is unrevealing.

— TL Schwenk

Published in Journal Watch General Medicine August 26, 1997

Citation(s):

Benito N et al. Bone marrow biopsy in the diagnosis of fever of unknown origin in patients with acquired immunodeficiency syndrome. Arch Intern Med 1997 Jul 28 157 1577-1580.

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