Drug Fever Induced by Piperacillin/Tazobactam in a Scoliosis Patient: A Case Report

Drug fever induced by antibiotics of β-lactams in a patient after posterior cervical spine surgery-A case report and literature review

Drug fever is a febrile reaction that emerges temporarily with the administration of a drug or a variety of drugs and disappears after cessation of the targeting agent. There are a few previous reports about drug fever, but they pertain mainly to patients accompanied by no surgical intervention. Based on the literature reviewed, drug fever in patients after posterior cervical spine surgery has never been mentioned before; therefore, we present a 56-year-old man diagnosed with drug fever after posterior cervical spine surgery for traumatic cervical myelopathy. Fortunately, his body temperature rapidly came down in 2 days after discontinuing the antibiotics. He was discharged after two more days of observation, and the patient recovered well without any further complaints. Early diagnosis of drug fever may greatly reduce inappropriate and potentially detrimental diagnostic and therapeutic interventions. For patients with persistent fever, if it happened days after surgery, particularly when it is without any infectious evidence, then it is necessarily important to consider a possible reason of drug-induced fever.

Antibiotic-induced fever in orthopaedic patients-a diagnostic challenge

INTRODUCTION

Antibiotic-induced fever is a probably underestimated complication, which may be misdiagnosed as new infection. In this study, characteristics, diagnostic approach, and outcome of antibiotic-induced fever in patients treated for musculoskeletal infections are described.

METHODS

We retrospectively reviewed all patients with antibiotic-induced fever after surgery treated at our institution from 2014 to 2017. Antibiotic-induced fever was diagnosed, if the following criteria were fulfilled: (i) central (ear) body temperature > 38.0 °C; (ii) intravenous antibiotics for > three days; (iii) exclusion of infectious or other non-infectious causes of fever; and (iv) defervescence after discontinuation of antibiotics.

RESULTS

We included 11 patients (median age 51 years) treated for infection after fracture fixation (n = 5), periprosthetic joint infections (n = 3), infection after spinal instrumentation (n = 1), and soft tissue infection (n = 2). The suspected antibiotics inducing fever were beta-lactam antibiotics (n = 9), vancomycin (n = 3), daptomycin (n = 2), clindamycin, and meropenem (n = 1 each). Additional clinical findings were reduced general condition, generalized exanthema, and rigors, whereas five patients were asymptomatic apart from a fever. Leukopenia was observed in nine patients and increase of C-reactive protein value in ten patients. Fever occurred after a median of 20 days of antibiotic treatment and resolved after a median of one day after discontinuation of the suspected antibiotic.

CONCLUSIONS

Antibiotics should be considered as the possible cause of fever in orthopaedic patients receiving antimicrobial treament whenever clinical signs of new or persisting infection are lacking. Important hints suggestive for antibiotic-induced fever are good general condition despite high temperature and progressive leukopenia. Discontinuation or change to another substance leads to prompt defervescence, preventing unnecessary diagnostic procedures and antibiotic treatment.

Doxycycline-induced drug fever: a case report

Drug fever is a febrile reaction induced by a drug without additional clinical symptoms. This adverse reaction is not rare but under diagnosed and under reported. Doxycycline is a tetracycline compound with broad-spectrum antibiotic activity. Drug fever induced by doxycycline is rarely reported. In this study, we describe a patient in whom doxycycline induced drug fever after 17 days of therapy for brucellosis.

Drug fever induced by piperacillin/tazobactam in an elderly patient with underlying human immunodeficiency virus (HIV) infection

Our search of the literature revealed no detailed case reports about drug fever induced by piperacillin/tazobactam in a patient with HIV infection although there were a few case reports about drug fever due to piperacillin/tazobactam with other comorbidities. A 63-year-old male patient with HIV positive was admitted for acute cholecystitis. He was started on piperacillin/tazobactam. For the next 8 days, he had intermittent fever up to 103°F (39.4°C) with relative bradycardia although he showed clinical improvement. There was no laboratory or imaging findings suggestive of another infectious source and drug fever was suspected. The antibiotics were stopped and after 48 hours no fever was observed until the day of discharge. Piperacillin/tazobactam can induce fever in patients with cystic fibrosis and in patients with other conditions. Drug fever may be more prevalent in patients with HIV infection. It has no characteristic pattern and may not be associated with eosinophilia.