Drug fever
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
- 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
Non-infectious
- Critical
- 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 syndrome
- Sweet's syndrome
Evaluation
Workup
- Thorough history and physical exam including review of medications
Diagnosis
- Diagnosis of exclusion
Management
- Withdrawal of offending agent