BONE-MARROW BIOPSY IN THE DIAGNOSIS OF FEVER OF UNKNOWN ORIGIN IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Background: Fever is commonly observed in patients with human immunode ficiency virus (HIV) disease and frequently eludes diagnosis. The role of bone marrow biopsy in the diagnosis of fever of unknown origin in patients infected with HIV remains controversial. Patients and Methods : One hundred twenty-three consecutive patients with 137 episodes of f ever lasting 10 or more days without diagnosis after 1 week of hospita lization were evaluated by bone marrow biopsy. Results: Overall, a spe cific diagnosis was achieved in 52 episodes by means of culture and hi stopathological examination (diagnostic yield, 37.9%). Three types of disease were found: mycobacterial infections (n=36, 69% of documented episodes), including 18 patients with disseminated tuberculosis and 14 with Mycobacterium avium-intracellulare complex infections; nonHodgki n lymphomas (n=12, 23%); and visceral leishmaniasis (n=4, 8%). Althoug h bone marrow cultures were more sensitive than microscopic examinatio n with special stains for the diagnosis of mycobacterial infections, t he pathological examination of bone marrow led to a more rapid diagnos is of disease. In addition, the histopathological examination of bone marrow alone led to the diagnosis of a specific condition in 43 episod es (31.3% of all episodes). Conclusions: Bone marrow biopsy is a usefu l procedure for the diagnosis of fever in patients with advanced HIV d isease, particularly in areas where tuberculosis and leishmaniasis are prevalent. Involvement of the marrow may be the first indication of t he existence of extranodal non-Hodgkin lymphoma. For Mycobacterium avi um-intracellulare complex infection, blood cultures were more sensitiv e than bone marrow biopsy.