PURPOSES: Ten to fifteen percent of @entity99 are idiopathic. If symptoms like prolonged @entity221 are present, empirical treatment is discussed. The goal of this study is to describe the empirical treatment proposed in this situation by French specialists of internal medicine. METHODS: We conducted a practice investigation among the French national society of internal medicine (SNFMI), using an anonymous questionnaire that related a case of @entity99 . This questionnaire was proposed to all French internists present at the SNFMI congress in June and December 2004. French specialists of internal medicine had to answer if they would prescribe an empirical treatment and if so, to specify this treatment. RESULTS: Thirty-six French specialists of internal medicine answered to the questionnaire. In the proposed situation, 89% of them initiate an empirical treatment. In 18/36 cases (50%), a first-line anti- @entity378 empirical treatment is proposed (quadritherapy in 11 cases). In 7 cases (19%), an empirical treatment with @entity229 , 0.4 mg/kg/d (N=1) and 1 mg/kg/d (N=6), would be prescribed. Seven internists (19%) would prescribe an empirical treatment with cyclins at the dose of 100 to 400 mg/d. Median duration of the empirical treatment would be 28 days (range: 8-252d). The evaluation parameters mentionned are: @entity221 (69%), weight (59%), seric level of @entity1851 (59%), and liver biology (53%). In case of failure of first-line empirical treatments, 69% of all questionned internists prescribe a second-line treatments: @entity229 at the dose of 0.4 to 2 mg/kg/d (72%), anti- @entity378 treatments (16%), cyclins 200 mg/d (12%), with a median duration of 28 days. Seven internists (19%) propose to combine two empirical treatments. DISCUSSION: Faced with a problem of @entity99 , French internists questionned propose four therapeutics options: no treatment, anti- @entity378 treatment, cyclins or @entity230 treatment. First-line anti- @entity378 treatment is a coherent proposition regarding to the high prevalence of @entity378 . There are only few data available concerning empirical treatment with @entity230 or cyclins. Specific proposition of such empirical treatments should be defined. CONCLUSIONS: The management of @entity99 is difficult. Our study shows that therapeutics practices of French internists are heterogenous. The main proposition consists in a first-line anti- @entity378 empirical treatment, that has to be evaluated after four weeks, and switched with @entity230 ( @entity229 , 1 mg/Kg/d) in case of failure. This study is not an expert proposition but contributes to suggest clinical practice guidelines for a rare, complex, heterogenous, and typically internist situation.

[Empirical treatment of XXXX of unknown origin: practice investigation in the French National Society of Internal Medicine].

@entity229 :: ('MESH:D011241', 'Chemical') :: ['prednisone'] @entity230 :: ('MESH:D013256', 'Chemical') :: ['steroids'] @entity378 :: ('MESH:D014376', 'Disease') :: ['tuberculosis'] @entity99 :: ('MESH:D056486', 'Disease') :: ['idiopathic granulomatous hepatitis', 'granulomatous hepatitis'] @entity221 :: ('MESH:D005334', 'Disease') :: ['fever'] @entity1851 :: ('1401', 'Gene') :: ['C-reactive protein']
@entity99 :: (MESH:D056486,Disease) :: ['granulomatous hepatitis']
