Sublingual misoprostol and hyperpyrexia: case report with temperature curve

Misoprostol administration mimicking a febrile transfusion reaction

BACKGROUND

Misoprostol, a synthetic prostaglandin E1 analogue, is widely used in obstetrics for its uterotonic properties. It is known to cause thermogenic side effects, a fact well-recognized in obstetrics but less familiar in transfusion medicine.

STUDY DESIGN AND METHODS

Data were collected through chart review, including temperature recordings, serologic findings, and blood culture results.

RESULTS

This case report describes a postpartum temperature spike to 39.2°C in a G1P0 female who received a red cell transfusion shortly after administration of misoprostol. Serologic workup for transfusion reaction showed no abnormalities, and blood cultures of both the patient and donor were negative for growth. Febrile nonhemolytic transfusion reaction (FNHTR) remained in the differential, however, the fever was attributed to misoprostol's thermogenic effect rather than a transfusion reaction.

DISCUSSION

Increased awareness of misoprostol's thermogenic effects in transfusion medicine may improve differential diagnosis, reduce unnecessary testing, and enhance patient satisfaction by avoiding unwarranted concerns regarding transfusion reactions.

High fever after sublingual administration of misoprostol for treatment of post-partum haemorrhage: a hospital-based, prospective observational study in Argentina

Objective

To characterise the occurrence of fever (≥38.0°C) after treatment for post‐partum haemorrhage (PPH) with sublingual misoprostol 800 mcg in Latin America, where elevated rates of misoprostol’s thermoregulatory effects and recipients’ increased susceptibility to high fever have been documented.

Methods

A prospective observational study in hospitals in Argentina enrolled consenting women with atonic PPH after vaginal delivery, eligible to receive misoprostol. Corporal temperature was assessed at 30, 60, 90 and 120 min post‐treatment; other effects were recorded. The incidence of high fever ≥ 40.0°C (primary outcome) was compared to the rate observed previously in Ecuador. Logistic regressions were performed to identify clinical and population‐based predictors of misoprostol‐induced fever.

Results

Transient shivering and fever were experienced by 75.5% (37/49) of treated participants and described as acceptable by three‐quarters of women interviewed (35/47). The high fever rate was 12.2% (6/49), [95% Confidence Interval (CI) 4.6, 24.8], compared to Ecuador’s rate following misoprostol treatment (35.6% (58/163) [95% CI 28.3, 43.5], P = 0.002). Significant predictors of misoprostol‐induced fever (model dependent) were as follows: pre‐delivery haemoglobin < 11.0g/dl, rapid placental expulsion, and higher age of the woman. No serious outcomes were reported prior to discharge.

Conclusions

Misoprostol to treat PPH in Argentina resulted in a significantly lower rate of high fever than in Ecuador, although both are notably higher than rates seen elsewhere. A greater understanding of misoprostol’s side effects and factors involved in their occurrence, including genetics, will help alleviate concerns. The onset of shivering may be the simplest way to know if fever can also be expected.