Differentials
Drug fever
SIGNS / SYMPTOMS
Drug fever may be associated with eosinophilia (often absent in neutropenic hosts), acute interstitial nephritis, hepatitis, and/or rash.
Drug fever should improve with discontinuation of the offending agent.
INVESTIGATIONS
FBC: eosinophilia.
Culture and molecular assay: negative for pathogen.
Tumour fever
SIGNS / SYMPTOMS
Progression of the underlying malignancy can be associated with tissue necrosis and inflammation that can yield low-grade or high fevers that do not improve with antibiotics.
Tumour fever often responds to the administration of non-steroidal anti-inflammatory drugs.
INVESTIGATIONS
Culture and molecular assay: negative for pathogen.
Imaging may demonstrate progression of disease.
There are no specific laboratory tests to indicate a tumour fever. It is usually a diagnosis of exclusion when fevers persist, despite negative cultures and broad antibiotic coverage.
Thromboembolism
SIGNS / SYMPTOMS
Malignancy is a risk factor for thrombosis, which can cause fever, especially in the setting of compromised blood flow to tissue with associated necrosis.
Signs or symptoms of deep vein thrombosis (e.g., extremity pain, erythema, or swelling), pulmonary embolism (e.g., chest pain, hypoxaemia), or cerebral embolism (e.g., sensory loss, facial weakness, cognitive deficits, speech disturbance) may be present.
INVESTIGATIONS
Doppler ultrasound, CT angiogram of the chest and/or brain, and echocardiogram (either trans-thoracic or trans-oesophageal) will reveal the presence of a thrombus or thromboembolic disease.
Use of this content is subject to our disclaimer