Drug fever: Difference between revisions

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*Also known as drug-induced hyperthermia
*Also known as drug-induced hyperthermia
*An adverse reaction to a drug in which the recipient of the drug develops a fever
*An adverse reaction to a drug in which the recipient of the drug develops a fever
**Most common classes associated with drug fever are antimicrobials, anticonvulsants, antidysrhythmics, and other cardiac agents<ref>Patel, R. A., & Gallagher, J. C. (2010). Drug Fever. Pharmacotherapy, 30(1), 57–69. doi:10.1592/phco.30.1.57</ref>
**Most common drug classes are antimicrobials, anticonvulsants, antidysrhythmics, and other cardiac agents<ref>Patel, R. A., & Gallagher, J. C. (2010). Drug Fever. Pharmacotherapy, 30(1), 57–69. doi:10.1592/phco.30.1.57</ref>


===Pathophysiology===
===Pathophysiology===
There are multiple mechanisms by which a drug can directly cause a fever response. These mechanisms include inducing a hyper-metabolic state, direct tissue damage and tissue necrosis, interference with peripheral vasodilation, activation of the cellular or humoral immune responses, or by acting as an endogenous pyrogen. <ref>Wikipedia, the Free Encyclopedia, "Drug-Induced hyperthermia" <https://en.wikipedia.org/wiki/Drug-induced_hyperthermia>, accessed 13 Jan 2021</ref>
Possible mechanisms:
*Hyper-metabolic state
*Direct tissue damage and tissue necrosis
*Interference with peripheral vasodilation
*Activation of the cellular or humoral immune responses
*Acting as an endogenous pyrogen.


==Clinical Features==
==Clinical Features==
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==Differential Diagnosis==
==Differential Diagnosis==
===[[Fever]]===
{{Acute Fever DDX}}
====Infectious====
*Critical
**[[Sepsis]]
**[[PNA]] with respiratory failure
** Peritonitis
** [[Meningitis]]
** [[Cavernous Sinus Thrombosis]]
** [[Necrotizing Fasciitis]]
*Emergent
** [[PNA]]
** [[Peritonsillar Abscess]]
** [[Retropharyngeal Abscess]]
** [[Epiglottitis]]
** [[Endocarditis]]
** [[Pericarditis]]
** [[Appendicitis]]
** [[Cholecystitis]]
** [[Diverticulitis]]
** Intra-abdominal abscess
** [[Pyelonephritis]]
** [[Tubo-ovarian abscess]]
** [[Encephalitis]]
** Brain abscess
** [[Cellulitis]]
** [[Abscess]]
** [[Malaria]]
*Non-emergent
**[[Viral syndrome]]
** [[Otitis Media]]
** [[Sinusitis]]
** [[Pharyngitis]]
** [[Influenza]]
** [[TB]]
** [[UTI]]
** [[Epididymitis]]
** [[Prostatitis]]
 
====Non-infectious====
*Critical
** [[AMI]]
** [[PE]]
** [[Intracranial Hemorrhage]]
** [[CVA]]
** [[NMS]]
** [[Thyroid Storm]]
** [[Acute Adrenal Insufficiency]]
** [[Transfusion Rx]]
** [[Pulmonary Edema]]
** [[Heat Stroke]]
** [[Malignant hyperthermia]]
*Emergent
** [[CHF]]
** [[Dehydration]]
** Recent [[Seizure]]
** [[Sickle Cell Dz]]
** Transplant rejection
** [[Pancreatitis]]
** [[DVT]]
** [[Serotonin Syndrome]]
*Non-emergent
** [[Drug fever]] (except as in [[NMS]] and [[Serotonin Syndrome]])
** Malignancy
** [[Gout]]
** Sarcoidosis
** [[Crohn's Disease]]
** Postmyocardiotomy sy


==Evaluation==
==Evaluation==
===Workup===
*Thorough history and physical exam including review of medications
*Thorough history and physical exam including review of medications
===Workup===


===Diagnosis===
===Diagnosis===
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==References==
==References==
<references/>
<references/>
[[Category:Toxicology]]

Latest revision as of 02:05, 27 November 2021

Background

  • Also known as drug-induced hyperthermia
  • An adverse reaction to a drug in which the recipient of the drug develops a fever
    • Most common drug classes are antimicrobials, anticonvulsants, antidysrhythmics, and other cardiac agents[1]

Pathophysiology

Possible mechanisms:

  • Hyper-metabolic state
  • Direct tissue damage and tissue necrosis
  • Interference with peripheral vasodilation
  • Activation of the cellular or humoral immune responses
  • Acting as an endogenous pyrogen.

Clinical Features

  • Can occur at any point during therapy but most often occurs 7-10 days after initiation of drug[2]
  • May appear "inappropriately well" for the degree of fever

Differential Diagnosis

Fever

Infectious

Non-infectious

Evaluation

Workup

  • Thorough history and physical exam including review of medications

Diagnosis

  • Diagnosis of exclusion

Management

  • Withdrawal of offending agent

Disposition

See Also

External Links

References

  1. ↑ Patel, R. A., & Gallagher, J. C. (2010). Drug Fever. Pharmacotherapy, 30(1), 57–69. doi:10.1592/phco.30.1.57
  2. ↑ Patel, R. A., & Gallagher, J. C. (2010). Drug Fever. Pharmacotherapy, 30(1), 57–69. doi:10.1592/phco.30.1.57
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