Drug Fever: Recent Cases From the Medical Literature

Marcia L. Buck, PharmD, FCCP, FPPAG, BCPPS


Pediatr Pharm. 2018;24(1) 

In This Article

Abstract and Introduction


Drug fever is conventionally defined as a fever above 38° C occurring after drug administration, without other potential causes, that ceases within 72 hours after drug discontinuation. Other symptoms may include chills, fatigue, and relative bradycardia (a lack of increase in heart rate in the presence of fever). Some definitions include the presence of a rash, while others exclude dermatologic symptoms. Laboratory testing may reveal thrombocytopenia, neutropenia, eosinophilia, increased aminotransferases, or an increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), although the presence of these results are not necessary to establish the diagnosis.[1,2] Drug fever is a diagnosis of exclusion and requires a thorough investigation for other causes of fever, including infection, recent surgery or trauma, malignancy, thromboembolic disease, collagen vascular diseases, gout, serum sickness-like reactions, serotonin syndrome, neuroleptic malignant syndrome, or malignant hyperthermia. The diagnosis of drug fever is challenging, and is particularly difficult when the patient is receiving the drug to treat a disease which presents with a fever. While a positive re-challenge can aid in confirming the diagnosis, it is not recommended due to the potential risk to the patient.