CLINICAL STUDY ON DRUG FEVER WITHOUT DRUG ERUPTION

• Published in: Japanese Journal of National Medical Services Vol. 44; no. 4; pp. 430 - 435
• Main Authors: SAITO, Shozo, KANAMARU, Minoru, KUBOTA, Shozo, MASUDA, Jun, UEHARA, Mutsumi, UEHARA, Masahiro, GOTO, Kazuhiro, CHISHIMA, Joichi, KUWABARA, Hidemasa
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 1990; 一般社団法人 国立医療学会
• Subjects: adverse reaction; antibiotics; drug fever; 副作用; 抗生物質; 薬剤熱
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.44.430

Drug fever without manifestation of so-called drug eruptions was studied so as to clarify its clinical characteristics. Between 1983 and 1988, eight patienus, three men and five women with a mean age of 90 years (range 38-75 years old), were identified according to the following criteria for drug fever: (1) It was an unexplained fever under a condition that might itself have caused a febrile state. (2) Fever coincided with the administration of the drug and then improved after discontinuation of the drug without other therapeutic measures. (3) The temperature remained normal thereafter, accompanied with a recovery of general condition from the unexplained fever. (4) There was no so-called drug eruption. Diagnosis was confirmed in four of the eight patients by rechallenge of the causative drugs. All patients had fever caused by the antibiotics which were administered; for infectious diseases in 7, for prophylactic use in 1. Other manifestations occurred in 2 patients (lymphnodes swellings in 2, polyarthritis in 1, and erythema nodosum in 1). Only 3 patients had prior histories of allergy. Fever pattens were high (≥36°C) in 6 patients, medium (38-39°C) in 1, low (<38°C) in 1. Duration of the drugs before the occurrence of drug fever ranged widely from 5 to 34 days. A relative eosinophilia was detected in only 2 patients. Erythrocyte sedimention rate, C-reactive protein and nuclear shift of neutrocytes were not helpful in making a differential diagnosis of drug fever against infectious disease. White blood cell counts ranged from 3500 to 6200/cmm. All intradermal skin tests of causative drugs showed negative. Patch test examined in 2 patients showed negative for both. Drug-induced lymphocyte stimulation test examined in 5 showed positive in 4. Circulating antibodies examined in 2 showed positive in 2. Drug fever disappeared within 24 hours in 5 patents, 3 days in 2 patients, but continued for more than 7 days after the drug discontinuation in 1 patient. Our data showed no specific clinical patterns to confirm the diagnosis of drug fever against the infectious disease. In conclusion, we reconfim that drug fever must be among first considerations for unexplained fever in any patient receiving medications.