Fever as the presenting manifestation of colon cancer: a case series of 11 patients

• Published in: La revue de medecine interne Vol. 34; no. 3; pp. 136 - 140
• Main Authors: Lecoules, S, Carmoi, T, Klotz, C, Rapp, C, Perrot, G, Galeano, C, Algayres, J-P
• Format: Journal Article
• Language: French
• Published: France 01.03.2013
• Subjects: Abscess - microbiology; Aged; Aged, 80 and over; Bacteremia - microbiology; Colonic Diseases - microbiology; Colonic Neoplasms - diagnosis; Female; Fever - etiology; Humans; Liver Abscess - microbiology; Male; Middle Aged; Recurrence
• ISSN: 1768-3122
• DOI: 10.1016/j.revmed.2012.08.008

Fever happens frequently in colon cancer but it is rarely the presenting manifestation. We report a case series of patients with colon cancer revealed by fever in the three military hospitals in Paris. Of the 11 patients studied, seven were men and four were women, and their mean age was 70 years. Cancer was localized in the sigmoid colon (n=6), left colon (n=3) and right colon (n=2). Cancer staging (UICC TNM classification 2002) was respectively pTis (n=1), I (n=4), II (n=3) and III (n=3). Fever was the only reason for admission and two patients had a recurrent fever of unknown origin. All patients but one had bacterial infection. Blood cultures grew up in six cases, Escherichia coli (n=3), Streptococcus gallolyticus (ex bovis) (n=2) and anaerobic bacteria (n=1). There was one case of infective endocarditis caused by S. gallolyticus. Imaging showed a liver abscess (n=3) and a colon cancer complicated by an abscess (n=3). In seven patients, a familial history of colon cancer and symptoms of underlying colic disease were present (neglected rectal bleeding, iron deficiency anaemia, clinical evidence of an abdominal mass). Fever may reveal colon cancer at an early stage. Its main cause is a bacterial infection, such as bacteremia or abscess. Fever of unknown origin is a rare presentation. Detailed history, careful clinical examination and analysis of imaging contribute to recommend the prescription of colonoscopy.