Drug fever: Difference between revisions
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==Background== | ==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<ref>Patel, R. A., & Gallagher, J. C. (2010). Drug Fever. Pharmacotherapy, 30(1), 57–69. doi:10.1592/phco.30.1.57</ref> | |||
===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== | ==Clinical Features== | ||
*Can occur at any point during therapy but most often occurs 7-10 days after initiation of drug<ref>Patel, R. A., & Gallagher, J. C. (2010). Drug Fever. Pharmacotherapy, 30(1), 57–69. doi:10.1592/phco.30.1.57</ref> | |||
*May appear "inappropriately well" for the degree of fever | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Acute Fever DDX}} | |||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*Thorough history and physical exam including review of medications | |||
===Diagnosis=== | ===Diagnosis=== | ||
* Diagnosis of exclusion | |||
==Management== | ==Management== | ||
* Withdrawal of offending agent | |||
==Disposition== | ==Disposition== | ||
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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
- 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