The role of the chest roentgenogram in febrile neutropenic patients

Article Abstract:

Patients with low white blood cell counts have an increased risk of infection, and fever in these patients generally warrants an exhaustive search for its source, and appropriate treatment. Patients with low white blood cell counts are called neutropenic, and are typically those who are undergoing chemotherapy for cancer or who are taking drugs to suppress their immune systems after organ transplants. When a neutropenic patient develops fever, he almost always has a chest X-ray, to look for pneumonia as a possible source of infection. In recent years, the routine use of chest X-rays has been questioned, as some studies have found that all of the neutropenic patients with abnormal chest X-rays have signs and symptoms of pneumonia, and the X-ray has added little new information. A series of 127 patients with a total of 195 episodes of fever were studied to determine if the chest X-rays they had were of any clinical benefit. These episodes of fever were classified as initial episodes, recurrent (if they occurred after a patient had been treated with antibiotics for some time with an initial resolution of fever), or persistent (if the patient never manifested a response to the antibiotics). Of the 146 initial fever episodes, 28 were associated with abnormal chest X-rays, 13 of which were felt to represent pneumonia. However, 12 of these 13 patients had clinical signs of pneumonia. As all of the patients had been started on antibiotics with their fevers, the X-ray results did not bring about any changes in therapy. Of 22 patients who had their fevers recur after initially responding to antibiotics, eight had abnormal chest X-ray findings, and five had their antibiotics changed because of the abnormal X-rays. All five subsequently improved. Of 27 patients with recurrent fever, five had newly abnormal chest X-rays, three had changes in their therapy, but only one of these patients improved. In this study, a total of 17 percent of the patients with abnormal chest X-rays had no clinical signs of pneumonia. Thus, this study suggests that in those patients with recurrent or persistent fevers, chest X-rays provide useful clinical information which can guide changes in antibiotic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

X-rays, Chest, Neutropenia, Thorax

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Persistent fever as the only symptom of familial Mediterranean fever

Article Abstract:

Familial Mediterranean fever (FMF) is an inherited disorder. The disease generally involves recurrent episodes of fever which are accompanied by joint pain, as well as pain in the chest and abdomen. Significant inflammation occurs in the synovial sacs of the joints, the peritoneal lining of the abdomen, and the pleural cavities surrounding the lungs. A case is presented, however, in which fever appears to be the only symptom. The 54-year-old man had recurring fever during a 10-year period without the other symptoms of FMF. A brother and two sons of the patient suffered from FMF, which was finally suspected as a diagnosis only when no other potential cause of the fever could be found. The patient refused exploratory surgery. On the possibility that FMF could be involved, he was treated with colchicine, which is the standard treatment. The patient's condition responded quickly. On four occasions, the fever returned when the patient stopped taking the drug, and resolved when he began again. Computed tomography and magnetic resonance imaging of his body were normal. The patient had no symptoms of FMF other than fever, but his family history in combination with his response to colchicine suggests that familial Mediterranean fever is the appropriate diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Genetic disorders, Familial Mediterranean fever, Periodic disease

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Sulbactam-induced hyperpyrexia

Article Abstract:

Drug-induced hyperpyrexia is the elevation of body temperature above 106 degrees Fahrenheit due to taking certain medications. The drugs cimetidine, which is used to treat stomach and intestinal ulcers, and labetalol, which is used to lower blood pressure, have been reported to cause hyperpyrexia. The first report of hyperpyrexia caused by the antibiotic sulbactam, which inhibits the enzyme beta-lactamase, is described. A 42-year-old woman was admitted to the hospital because of gunshot wounds to the left thigh and groin. The affected tissue deteriorated and because of reduced blood supply, the patient required a below-the-knee amputation. To prevent infection of the wound, she was initially treated with the antibiotic ampicillin, which produced no adverse side effects. However, the patient developed infections with microorganisms that produce the enzyme beta-lactamase. She was given the beta-lactamase inhibitor, sulbactam, with ampicillin, and within 30 minutes she developed hyperpyrexia. The elevation of body temperature did not develop when ampicillin was given alone, and could not be attributed to other drugs, administered fluids, or allergy. The evidence suggests that the antibiotic sulbactam can cause drug-induced hyperpyrexia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Antibiotics, Complications and side effects, Enzyme inhibitors, Pyrogens

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