Diagnostic Utility of Bone Marrow Examination in Pyrexia of Unknown Origin: A Prospective Study from a Tertiary Care Centre

Abstract

Background: Pyrexia of unknown origin (PUO) remains a significant diagnostic challenge in clinical practice due to its diverse aetiologies and nonspecific clinical presentation¹–³. Bone marrow examination should be considered early in the diagnostic algorithm of PUO. Despite advances in imaging and laboratory investigations, a considerable proportion of cases remain undiagnosed after initial evaluation. Bone marrow examination is a minimally invasive diagnostic procedure that can provide valuable insights into infectious, haematological, and inflammatory causes of PUO, particularly in resource-limited settings⁴–⁶.

Objective: To evaluate the diagnostic utility of bone marrow aspiration and trephine biopsy in patients presenting with PUO.

Methods: This prospective observational study was conducted on 80 patients presenting with PUO at a tertiary care centre. All patients underwent bone marrow aspiration and trephine biopsy under aseptic precautions. Smears were stained with Leishman stain, and biopsy sections were stained with Hematoxylin and Eosin (H&E). Special stains, including Ziehl–Neelsen (ZN) and Periodic acid–Schiff (PAS), were applied where indicated¹³–¹⁵. Clinical and laboratory data were recorded, and results were analyzed using descriptive statistical methods.

Results: Bone marrow examination established a definitive diagnosis in 62% (50/80) of cases. Infectious etiologies were the most common, accounting for 40% of cases, with granulomatous inflammation observed in 25% and tuberculosis confirmed by acid-fast bacilli positivity in 15% of cases⁶,¹⁶. Non-infectious causes included haematological malignancies (12.5%) and hemophagocytic lymphohistiocytosis (10%)²¹–²³. The predominance of infectious causes was statistically significant (p < 0.05). A considerable proportion of cases (37.5%) remained inconclusive.

Conclusion: Bone marrow examination is a safe, cost-effective, and highly valuable diagnostic modality in the evaluation of PUO. It offers a high diagnostic yield, particularly in detecting infectious and haematological causes¹⁷,¹⁸. Early utilisation can significantly reduce diagnostic delay and improve clinical outcomes, especially in developing countries where infectious diseases are prevalent⁵–⁷.