The clinical approach to the noninfectious disorders with fever is usually relatively
straightforward because they are readily diagnosable by history, physical, or routine
laboratory or radiology tests. By knowing that noninfectious disorders are not associated
with fevers> 1028 F, the clinician can approach patients with these disorders that have fevers
1028 F by looking for an alternate explanation. The difficulty usually arises when the patient
has a multiplicity of conditions and sorting out the infectious from the noninfectious causes
can be a daunting task (Tables 3 and 4) (1–6,10).
Table 2 Causes of Extreme Hyperpyrexia (High Fevers 1068 F)
. Hypothalamic disease/dysfunction
. Central fevers (hemorrhagic, trauma, infection, malignancy)
. Malignant neuroleptic syndrome
. Malignant hyperthermia
. Drug fever (typically 102 8 F–106 8 F)
. Tetanus
Table 1 Causes of Fever in the CCU
System/Source Infectious causes Noninfectious causes
. Central nervous Meningitis
Encephalitis
Cerebral infarction
Cerebral hemorrhage
Seizures. Cardiovascular Endocarditis
Intravascular device infection
Central Venous Catheter (CVC)-
associated bacteremia
Septic thrombophlebitis
Pacemaker infection
Postperfusion syndrome (CMV)
Myocardial infarction
Dressler’s syndrome
Postpericardiotomy syndrome
Thrombophlebitis. Pulmonary Pneumonia
Empyema
Tracheobronchitis
Sinusitis
Deep vein thrombosis
Atelectasis
Chemical pneumonitis
Pulmonary emboli/infarction. Gastrointestinal Intra-abdominal abscess
Cholecystitis/cholangitis
Viral hepatitis
Peritonitis
Diverticulitis
C. difficilecolitis
Gastrointestinal hemorrhage
Acalculous cholecystitis
Nonviral hepatitis
Pancreatitis
Inflammatory bowel disease
Ischemic colitis. Renal Urinary tract infection (Cystitis)
Acute pyelonephritis
. Rheumatologic Osteomyelitis
Septic arthritis
Gout/pseudogout
Collagen vascular disease (SLE)
Vasculitis. Skin/soft tissue Cellulitis
Wound infection
Hematoma
Intramuscular injections
Burns. Endocrine/metabolic Adrenal insufficiency
Hyperthyroidism/thyroiditis
. Miscellaneous Sustained bacteremias
Transient bacteremias
Parotitis
Pharyngitis
Alcohol/drug withdrawal
Drug fever
Postoperative/postprocedure
Blood/blood products transfusion
Intravenous contrast reaction
Fat emboli syndrome
Neoplasms/metastasis2 Cunha