Introduction: We examined the causative diseases of patients presenting with a chief complaint of fever.

Methods: The patients were new patients visiting the Department of General Medicine at the University of Tsukuba Hospital between April 2018 and March 2020. The chief complaints were obtained from the patients' medical records, categorized according to the International Classification of Primary Care Second Edition. Patients with fever (A03) as the chief complaint were enrolled and their diagnoses were investigated.

Results: Of 610 eligible patients, 85 had fever as the chief complaint. Causative diseases were infectious disease in 31 patients (36%), noninfectious inflammatory diseases in nine patients (11%), malignancy in three patients (3%), others in 14 patients (16%), unknown in 19 patients (22%), and exhibiting no pathologic conditions in nine patients (11%). Specific diagnoses were viral infection for the infectious disease patients, collagen diseases for the noninfectious inflammatory disease patients, hematologic diseases for the malignancy patients, and drug-related issues for others.

Conclusion: The most common cause of fever was infectious diseases. Some patients were concerned about disease even when their temperatures were in the physiologic range.

Shoulder pain is a frequent complaint among adults. The origins of shoulder pain are manifold. Recently, a relationship between musculoskeletal pain and stacking fascia has been reported. Herein, we report a patient with intractable shoulder pain that was improved by hydrorelease. The patient visited our hospital after experiencing pain on motion and a limited range of motion in the left glenohumeral joint for 6 months. Hydrorelease (xylocaine + saline) was performed around the scapula, and betamethasone + xylocaine injections were added to the subacromial bursa and long head of the biceps tendon (LHBT), but the symptoms did not improve. A physical therapist performed a passive shrug on the patient's left shoulder joint from the first position, which elicited pinpoint pain in the anterior aspect of the shoulder. The patient was found to have tenderness in the same area, and ultrasonographic evaluation revealed stacking fascia in the transverse ligament around the LHBT. Following hydrorelease, the patient experienced relief of the symptoms.

Passive shrug of the shoulder joint elicited pain in a region of the stacking fascia that had not been identified by other physical examinations. By identifying the source of the pain through a physical examination by a physical therapist, we were able to effectively treat the patient and obtain pain relief.

Multidisciplinary collaboration between child psychiatry, childcare services, education, and government agencies has been a long-standing practice. Family physicians because of their involvement in social prescribing, naturally complement child psychiatry. Additionally, psychiatric patients who present with somatization in childhood often share similarities with those seen in general medical settings. Thus, providing child psychiatry training for family physicians may open the possibility for them to obtain a specialty in child psychiatry.