Background and purpose: Fever of unknown origin is a frequent disorder in pediatric age.The aim of this study was to determine the causes of fever of unknown origin and; to evaluate diagnostic tests.Materials and Methods: Cases were identified by reviewing the medical records of all patients with FUO which were admitted in three medical centers in Tehran during March 1994- 99.Results: Infection was the most frequent cause of fever of unknown origin. Neoplastic disorders occurred in children older than one year. Abdominal ultrasonography was performed in 71 patients (61%) and was helpful in diagnosis of 15% of the cases.Conclusion: The improvement in diagnostic procedures has conditioned a change of spectrum of the diseases. In most cases the etiological diagnosis can be made with a limited number of laboratory and/ or imaging investigations bases upon a careful clinical evaluation.

Primary cardiac tumors are rare and occur in 1 per 1000 to 1 per 100000 individual in unselected autopsy series at tertiary heart centers .Approximately 75% of cardiac tumors are histologically benign and malignanat cardiac tumors are reminder of them. We describe a rare form of complicated benign cardiac mass in 46 years old man.

Lead may cause toxicity in case of frequent occupational exposure or non-occupational exposure as a result of water, soil, and air pollution. Opium abuse is an important cause of lead poisoning among the people in Middle East, including Iran. Symptoms are not specific and include fatigue, impaired concentration and memory, and non-specific abdominal pain. The abdominal pain which is known as lead colic is in differential diagnosis with other common and emergent causes of abdominal pain. The key to making an accurate diagnosis in these cases, is to focus on a precise history to investigate any probable exposure. Measurement of the serum lead level will help in making definite diagnosis in suspected cases. The present article introduces a young man attending an emergency department with abdominal pain. He ignored any occupational lead exposure or opium abuse. When all clinical and para-clinical investigations failed to detect the cause of pain, serum lead level was tested which revealed lead poisoning. After taking more precise history, he finally disclosed using oral opium. He underwent treatment with Dimercaprol 10 mg 3 times per day for 5 days, then twice a day and all symptoms resolved within two weeks.

A 52-year-old man referred with fever for 40 days. On examination, he had no abnormal finding except for a slightly enlarged thyroid gland. Thyroid function tests demonstrated a thyrotoxic state with reduced uptake of radioiodine (RAI-U) compatible with subacute thyroiditis (SAT). He had leukocytosis, raised ESR and a painless nontender thyroid gland.

Introduction: The origin of metastatic Melanoma is unknown in approximately 5-10% of the patients. Various suggestions have been made for the primary origin of this lesion. In this article, a rare case of metastatic Melanoma is reported in submandibular area.Case presentation: A 20 year-old woman was referred with a cystic lump in the submandibular area. She reported a pigmented macule on her lip that was completely regressed at the time of clinical evaluation. Excisional biopsy showed the lesion to be Metastatic Melanoma. The diagnosis was confirmed by Immuno-histochemcial staining for HMB45 and S100 markers. The patient is reported to be free of disease in four-year follow up based on the clinical as well as Para clinical evaluation.Conclusion: Total excision of the solitary lesion is suggested in patients with metastatic Melanoma with unknown origin and regression of the primary lesion.

Objective(s): Only few studies have assessed the use of gallium citrate-67 single-photon emission computed tomography/computed tomography (67Ga-SPECT/CT) for localizing the foci of classic fever of unknown origin (FUO) and Inflammation of unknown origin (IUO). Hence, the current study aimed to assess the diagnostic contribution of 67Ga-SPECT/CT in a tertiary referral setting where nuclear imaging tests are performed after an unsuccessful comprehensive primary diagnostic workup. Methods: We retrospectively assessed the medical records of 27 adult patients with FUO/IUO who had an unsuccessful diagnostic workup and who underwent 67Ga-SPECT/CT for the localization of FUO/IUO foci in our university hospital between 2013 and 2019. The primary outcome was diagnostic yield. The secondary outcomes were overall clinical efficacy and spontaneous remission of FUO/IUO symptoms in patients with a negative 67Ga-SPECT/CT finding. Results: Almost all patients completed the recommended diagnostic workup, except for urine culture and abdominal ultrasonography. Moreover, prior to 67Ga-SPECT/CT, all patients underwent thoraco-abdominopelvic CT scan, which was a non-diagnostic procedure. After a median follow-up of 843 days, the cause was identified in 16 (59%) patients. 67Ga-SPECT/CT successfully localized the FUO/IUO foci in eight patients (diagnostic yield = 30%; 95% confidence interval [CI]: 14%– 50%). However, the causes remained unknown during follow-up in 11 (41%) patients. Among them, five experienced spontaneous regression of symptoms. 67Ga-SPECT/CT was negative in four of the five patients with spontaneous regression in symptoms without a definite cause. Considering this an important event, the overall clinical efficacy of 67Ga-SPECT/CT increased to 44% (95% CI: 25%– 65%). Conclusion: 67Ga-SPECT/CT had an acceptable diagnostic yield for the localization of FUO/IUO foci, which are challenging to diagnose, in a contemporary tertiary referral care setting. In patients who experienced spontaneous regression in symptoms with an unexplained cause, the absence of abnormal uptake might indicate prospective spontaneous remission. Thus, 67Ga-SPECT/CT could be an active first-line nuclear imaging modality in settings where fluorine-18-fluorodeoxy glucose positron emission tomography and computed tomography is not available for the assessment of FUO/IUO causes.

Introduction: Fragile X syndrome (FXS) is one of the most prevalent genetic causes of developmental disability, representing the most frequent form of inherited severe cognitive deficit. The present study was undertaken to investigate FXS and its prevalence in moderate mentally retarded people in patients.Materials and methods: Nineteen people with moderate mental retardation (MR) who were clinically suspicious to have FXS were screened for FXS by using cytogenetic and molecular methods. Blood samples were collected and cultured in specific culture media. G-Banding method was used for karyotyping. To ensure correct results of cytogenetic testing, four suspected case of FXS were tested by PCR. Results were analyzed using logistic regression analysis.Results: Four patients (4%) were found to express fragile X site at q27.3. The results showed that the relationship of FXS with familial, economic status was not significant, but the relationship of FXS with MR and family history was significant.Conclusion: The frequency of FXS positive cases found in this study is similar to other reports of FXS in preselected patients.

Patients with subacute or glaucomatous thyroiditis usually come to the physician with fever, Anterior cervical pain and they show tenderness in palpation during physical examination. Occasionally, clinical presentation is atypical and it is possible that it is taken as systemic or malignant diseases wrongfully.Here, we reported a 27 years old girl with FUO that the final diagnosis was subacute thyroiditis. The diagnosis was done through abnormal thyroid function tests, thyroid scan, suppressed radio - iodine uptake and excellent response to Aspirin.