Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used ...Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms. Since the patient's fever was of unknown origin, she was hospitalized. All treatment was stopped and an extensive workup to explore the source of fever and chills was performed. Results of chest X-ray, viral, urine, and blood cultures, autoimmune serology, transthoracic and transesophageal echocardiography, and abdominal ultrasound revealed no source of infection. A rechallenge test of azathioprine was performed and the fever and chills returned within a few hours. Azathioprine was established as the definite cause following rechallenge. Fever as an adverse drug reaction is often unrecognized. Azathioprine has been reported to cause druginduced fever in patients with inflammatory bowel disease, rheumatoid arthritis, and sarcoidosis. To the bestof our knowledge there have been no previous reports documenting azathioprine-induced fever in patients with autoimmune hepatitis. The occurrence of fever following the readministration of azathioprine suggests the diagnosis of drug-induced fever, particularly after the exclusion of other causes. A careful rechallenge is recommended to confirm the diagnosis.展开更多
Background: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and causes in the adult population have not been fully investigated. The purpose...Background: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and causes in the adult population have not been fully investigated. The purpose of the present study was to investigate the incidence of PEF and identify the risk factors associated with the development of PEF and its outcomes. Material and Methods: Over a three-month period, 1054 non-hospitalised patients who had an endoscopic procedure at Cleveland Clinic Abu Dhabi received a post-procedure phone call within the first 24 hours. After identifying patients with fever and obtaining verbal consent, patients were enrolled in the study using a standardised telephone interview. Results: Thirty-four patients with PEF were identified. The highest temperature measured was 39.8 degrees Celsius. Oesophagogastroduodenoscopy, as a single procedure, was the most commonly performed (41.2%). Logistic regression revealed that no significant group differences across procedure types existed in terms of adjusted odds of fever. However, results also indicated that age has a significant negative relationship with fever—higher age is associated with lower odds of fever (b = -0.033, p = 0.024). Conclusion: PEF is an unpleasant side effect and it is associated with patient discomfort, dissatisfaction and fear during post-endoscopy recovery. Although our findings do not fully explain the possible mechanisms underlying post-endoscopy fever, this study data should increase awareness about PEF as a common side effect related to endoscopy.展开更多
文摘Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms. Since the patient's fever was of unknown origin, she was hospitalized. All treatment was stopped and an extensive workup to explore the source of fever and chills was performed. Results of chest X-ray, viral, urine, and blood cultures, autoimmune serology, transthoracic and transesophageal echocardiography, and abdominal ultrasound revealed no source of infection. A rechallenge test of azathioprine was performed and the fever and chills returned within a few hours. Azathioprine was established as the definite cause following rechallenge. Fever as an adverse drug reaction is often unrecognized. Azathioprine has been reported to cause druginduced fever in patients with inflammatory bowel disease, rheumatoid arthritis, and sarcoidosis. To the bestof our knowledge there have been no previous reports documenting azathioprine-induced fever in patients with autoimmune hepatitis. The occurrence of fever following the readministration of azathioprine suggests the diagnosis of drug-induced fever, particularly after the exclusion of other causes. A careful rechallenge is recommended to confirm the diagnosis.
文摘Background: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and causes in the adult population have not been fully investigated. The purpose of the present study was to investigate the incidence of PEF and identify the risk factors associated with the development of PEF and its outcomes. Material and Methods: Over a three-month period, 1054 non-hospitalised patients who had an endoscopic procedure at Cleveland Clinic Abu Dhabi received a post-procedure phone call within the first 24 hours. After identifying patients with fever and obtaining verbal consent, patients were enrolled in the study using a standardised telephone interview. Results: Thirty-four patients with PEF were identified. The highest temperature measured was 39.8 degrees Celsius. Oesophagogastroduodenoscopy, as a single procedure, was the most commonly performed (41.2%). Logistic regression revealed that no significant group differences across procedure types existed in terms of adjusted odds of fever. However, results also indicated that age has a significant negative relationship with fever—higher age is associated with lower odds of fever (b = -0.033, p = 0.024). Conclusion: PEF is an unpleasant side effect and it is associated with patient discomfort, dissatisfaction and fear during post-endoscopy recovery. Although our findings do not fully explain the possible mechanisms underlying post-endoscopy fever, this study data should increase awareness about PEF as a common side effect related to endoscopy.
