The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Inflammatory Origin of Fever Is Key to Diagnosis

Inflammatory Origin of Fever Is Key to Diagnosis

September 1, 2014 • By Simon M. Helfgott, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

You Might Also Like
  • Diagnosis Can Be Elusive for Fever of Unknown Origin
  • Opinion: More Tests Needed to Diagnose Fever of Unknown Origin
  • Diagnosis, Treatment for Patient with Psoriasis, Fever, Bloating, and Rash
Explore This Issue
September 2014
Also By This Author
  • Tobacco and Medicine: A Hazy Relationship
Today’s thermometers are a far cry from the foot-long device originally used to record body temperature.

Rheumatologists are careful historians. They listen attentively to their patients, scouring their histories for clues that might lead to the correct diagnosis. They are always on the hunt for tangible evidence of an inflammatory process, because many of the diseases they treat are characterized by a litany of subjective complaints and a paucity of physical findings. Among the most worrisome words they may hear in the patient’s history or observe firsthand in their exam is the f word. No, not that one! I am referring to fever.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

The presence of fever sounds an alarm, alerting caregivers to the possibility of infection and its dire consequences if the source and site are not quickly identified and treated appropriately. However, to rheumatologists, fever does not always connote infection. Clinical experience and recent research evidence have identified fever as a danger signal, apprising our brain and our immune system to excessive cytokine activation, whether due to infection or molecular mutations in the innate immune system.

Although fever is triggered by the stimulation of the thermoregulatory neurons nestled in the housekeeping hub at the base of our brains, better known as the hypothalamus, the cytokines that are critical for raising core temperature were only recently elucidated. Our colleague, Charles Dinarello, MD, professor of medicine at the University of Colorado in Denver, was the first investigator to observe that leukocyte pyrogen, a fever-inducing protein derived from white blood cells, alerted the hypothalamus to the danger lurking somewhere in the periphery.1

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Around the time of this seminal observation, I was a medical resident involved in the care of a patient whose febrile illness highlighted the perils of failing to promptly identify a fever’s inflammatory origins. Monique was a 22-year-old student who celebrated her graduation from college by taking an extended backpacking trip through Central America. She hiked for miles through muddy rain forests and trekked along many treacherous mountain trails. When she finally returned to Montreal sometime in the dead of winter (which, in Montreal, can be just about any month except July!), she developed a fever. At first, she ignored the prickly warm sensation coursing through her body, assuming it would soon pass. But after several days of spiking temperatures to 105°F, she found herself drenched in sweat, lying in a hospital bed.

Given her recent travel to Central America, the medical team focused on a laundry list of potential infectious possibilities. These included tropical diseases rarely seen north of the 49th parallel: Chagas disease, dengue fever, yellow fever, typhoid fever, malaria and mycobacterial infection. Myriad tissue and fluid cultures failed to provide any solid clues.

Pages: 1 2 3 4 5 6 | Single Page

Filed Under: Conditions, Crystal Arthritis, Opinion, Rheuminations, SLE (Lupus), Systemic Inflammatory Syndromes Tagged With: brain, crystal arthritis, fever, Gout, Helfgott, imaging, Infection, inflammatory, microbe, patient care, rheumatologist, Sarcoidosis, Systemic lupus erythematosusIssue: September 2014

You Might Also Like:
  • Diagnosis Can Be Elusive for Fever of Unknown Origin
  • Opinion: More Tests Needed to Diagnose Fever of Unknown Origin
  • Diagnosis, Treatment for Patient with Psoriasis, Fever, Bloating, and Rash
  • How to Recognize, Diagnose Periodic Fever Syndromes in Adults

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Patient & Caregiver Resources

Find a rheumatology provider. Learn about your condition and how to live with it. English and Spanish language resources.

View Patient & Caregiver Resources »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)