• Jan Holubar, Jonathan Broner, Erik Arnaud, Olivier Hallé, Thibault Mura, Benjamin Chambert, Albert Sotto, Camille Roubille, Cecile Gaujoux-Viala, and Radjiv Goulabchand.
• Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France.
• J. Intern. Med. 2022 Jun 1; 291 (6): 856-863.

BackgroundInflammation of unknown origin (IUO) is a challenging situation in internal medicine.ObjectivesTo describe the final diagnoses in IUO and assess the helpfulness of 18 F-fluorodesoxyglucose positron emission tomography with computerized tomography (18 F-FDG-PET/CT) in the diagnosis strategy.ResultsA total of 317 IUO patients with 18 F-FDG-PET/CT were enrolled. A diagnosis was reached in 228 patients: noninfectious inflammatory diseases (NIID) (37.5%), infectious diseases (18.6%), malignancies (7.9%), and non-systemic-inflammatory miscellaneous diseases (7.9%). The two leading causes of NIID were polymyalgia rheumatica and giant cell arteritis. 18 F-FDG-PET/CT results were classified as true positive in 49.8% of patients and contributory in 75.1% of overall IUO patients (after the complete investigation set and a prolonged follow-up). In multivariate analysis, only C-reactive protein minimum level (≥50 mg/L) was associated with the contributory status of 18 F-FDG-PET/CT.ConclusionWithin the wide spectrum of IUO underlying diseases, 18 F-FDG-PET/CT is helpful to make a diagnosis and to eliminate inflammatory diseases. Obese patients constitute a specific group needing further studies.© 2022 The Association for the Publication of the Journal of Internal Medicine.

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