title: [Drug-induced fever: a diagnosis to remember].
abstract: Drug fever (DF) is a febrile reaction induced by a drug without additional clinical features like skin eruption. This adverse drug reaction is probably common but under diagnosed. While its outcome is generally favourable, DF generates unnecessary diagnostic procedures as well as hospitalisations or hospitalisation prolongations. Clinical presentation and biological findings are not specific. Fever is generally well tolerated but may be accompanied by general symptoms mimicking sepsis. Moderate biological disorders could be expected, including elevation or decrease in white blood cell count, eosinophilia, liver cytolysis, and increased C-reactive protein. An infection should be systematically ruled out. Clinical or biological signs of severity should question DF diagnosis. When DF is suspected, the involved drug(s) should be stopped after a reliable assessment of imputability. Antibiotics represent the most often implicated drugs. Fever disappearance after discontinuing the suspected drug is the cornerstone of DF diagnosis. Before stopping the administration of the suspected drug(s), a risk/benefit ratio assessment is necessary. Consistently, it may be complicated to stop an antimicrobial drug when treating an infection or an immunosuppressive drug if required.
authors.affiliation: Réanimation médicale et toxicologique, hôpital Lariboisière, Assistance publique des Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Université Paris Diderot, 10, avenue de Verdun, 75010 Paris, France. Electronic address: dominique.vodovar@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Vodovar
authors.affiliation: Centre régional de pharmacovigilance, hôpital européen George-Pompidou, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Beller
authors.affiliation: Centre régional de pharmacovigilance, hôpital européen George-Pompidou, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France.
authors.forename: A
authors.initials: A
authors.lastname: Lillo-Le-Louet
authors.affiliation: Service de médecine interne, hôpital Ambroise-Paré, Assistance publique des Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt cedex, France; Université Versailles-Saint-Quentin, 45, avenue des États-Unis, 78000 Versailles, France.
authors.forename: T
authors.initials: T
authors.lastname: Hanslik
authors.affiliation: Réanimation médicale et toxicologique, hôpital Lariboisière, Assistance publique des Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Université Paris Diderot, 10, avenue de Verdun, 75010 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Megarbane
mesh_terms: D003937:Diagnosis, Differential; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000191:economics; D005334:Fever / Q000139:chemically induced* / Q000175:diagnosis* / Q000191:economics; D006801:Humans; D011364:Professional Practice / Q000592:standards; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis; D012720:Severity of Illness Index
keywords: Adverse drug reaction; Antibiotic; Antibiotique; Beta-lactamin; Béta-lactamine; Drug fever; Effet indésirable médicamenteux; Fever of unknown origin; Fièvre au long cours; Fièvre médicamenteuse