What are the noninfectious causes of fever and organ dysfunction that can mimic bacterial sepsis?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

There are numerous noninfectious causes of fever and organ dysfunction that can mimic sepsis: [11]

  • Alcohol/drug withdrawal
  • Postoperative fever (48 hours postoperatively)
  • Transfusion reaction
  • Drug fever
  • Allergic reaction
  • Cerebral infarction/hemorrhage
  • Adrenal insufficiency/adrenal hemorrhage
  • Myocardial infarction
  • Pancreatitis
  • Acalculous cholecystitis
  • Ischemic bowel
  • Aspiration pneumonitis
  • ARDS (both acute and late fibroproliferative phase)
  • Subarachnoid hemorrhage
  • Fat emboli
  • Transplant rejection
  • Deep venous thrombosis
  • Pulmonary emboli
  • Gout/pseudogout
  • Hematoma
  • Cirrhosis (without primary peritonitis)
  • Gastrointestinal hemorrhage
  • Phlebitis/thrombophlebitis
  • IV contrast reaction
  • Neoplastic fevers
  • Decubitus ulcers

Table 1. Infectious and Noninfectious Causes of Fever [12] (Open Table in a new window)

System

Infectious Causes

Noninfectious Causes

Central nervous

Meningitis, encephalitis

Posterior fossa syndrome, central fever, seizures, cerebral infraction, hemorrhage, cerebrovascular accident

Cardiovascular

Central line, infected pacemaker, endocarditis, sternal osteomyelitis, viral pericarditis, myocardial/perivalvular abscess

Myocardial infarction, balloon pump syndrome, Dressler syndrome

Pulmonary

Ventilator-associated pneumonia, mediastinitis, tracheobronchitis, empyema

Pulmonary emboli, ARDS, atelectasis (without pneumonia), cryptogenic organizing pneumonia, bronchogenic carcinoma without postobstructive pneumonia, systemic lupus erythematosus, pneumonitis, vasculitis

Gastrointestinal

Intra-abdominal abscess, cholangitis, cholecystitis, viral hepatitis, peritonitis, diarrhea (Clostridium difficile)

Pancreatitis, acalculous cholecystitis, ischemia of the bowel/colon, bleeding, cirrhosis, irritable bowel syndrome

Urinary tract

Catheter-associated bacteremia, urosepsis, pyelonephritis, cystitis

Allergic interstitial nephritis

Skin/soft tissue

Decubitus ulcers, cellulitis, wound infection

Vascular ulcers

Bone/joint

Chronic osteomyelitis, septic arthritis

Acute gout

Other

Transient bacteremia, sinusitis

Adrenal insufficiency, phlebitis/thrombophlebitis, neoplastic fever, alcohol/drug withdrawal, delirium tremens, drug fever, fat emboli, deep venous thrombosis, postoperative fever (48 h), fever after transfusion

An abdominal wall abscess is depicted on the CT scan below.


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