Drug-induced fever
Alerts and Notices
Synopsis

Common drugs that induce fever, by mechanism:
- Hypersensitivity – anticonvulsants, penicillin, minocycline, sulfonamide, allopurinol
- Altered thermoregulatory mechanisms – thyroxine, anticholinergics, amphetamines, cocaine
- Directly related to administration – paraldehyde, pentazocine, amphotericin B, bleomycin
- Direct extension of pharmacologic action – chemotherapy
- Idiosyncratic – succinylcholine, haloperidol, serotonergic
Risk of drug-induced fever increases with the number of medications taken, particularly in older adults and in those with active HIV infection. Patients with cystic fibrosis have a high incidence of drug-induced fever, most commonly from parenteral beta-lactams, piperacillin, and imipenem / cilastatin.
Codes
ICD10CM:R50.2 – Drug induced fever
SNOMEDCT:
405543000 – Drug-induced hyperpyrexia (Drug fever)
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- DRESS syndrome – Presents as diffuse morbilliform rash, atypical lymphocytosis, thrombocytopenia, eosinophilia, lymphadenopathy, and hepatitis; may reactivate herpes viruses; mortality is 5%-10%.
- Neuroleptic malignant syndrome – Presents as high fever (> 40ºC/104ºF), muscle rigidity, altered and fluctuating mental state, and dysautonomia in a patient taking antipsychotic drugs.
- Serotonin syndrome – Presents as hyperthermia, autonomic hyperactivity (diaphoresis, tachycardia), and neuromuscular disturbances (rigidity, hyperreflexia, clonus, tremors) in a patient taking serotonergic drugs.
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:01/07/2019
Last Updated:02/28/2019
Last Updated:02/28/2019