Is defined as fever caused by cancer itself. It has been shown to be the most common cause of fever of unknown origin in patients with cancer.
It is well known that Hodgkin’s disease, non-Hodgkin’s lymphomas, acute leukemias, and renal cell carcinomas frequently present with neoplastic fever, but it has been observed that almost any other cancer can cause neoplastic fever.
The major pyrogenic cytokines released by cancer cells include interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-α, and interferon.
It is usually characterized by a sensation of warmth and sweating, but manifests with less chills than other types of fever. Tachycardia and mental changes are lacking or mild. In contrast to fever due to infection, neoplastic fever is less responsive to acetylsalicylic acid and acetaminophen, but exhibits a more dramatic response to nonsteroidal anti-inflammatory drugs.
Initial consideration must be directed at common conditions, e.g., infections, perhaps related to marrow suppression and immune-compromised state, and febrile drug reactions due to chemotherapeutic and non-chemotherapeutic agents. If all the potential causes of fever are excluded, the possibility of neoplastic fever should be considered.
Diagnostic criteria for neoplastic fever
I. Temperature over 37.8°C at least once each day
II. Duration of fever of more than 2 weeks
III. Lack of evidence of infection on physical examination, laboratory examinations (cultures of blood, sputum, urine, stool, bone marrow, spinal or pleural fluid) and imaging studies (chest radiograph and computed tomographic scans of the head, abdomen, and pelvis)
IV. Absence of allergic mechanisms
V. Lack of response of fever to an empiric, adequate antibiotic therapy for at least 7 days
VI. Prompt, complete lysis of fever by the naproxen test with sustained normal temperature while receiving naproxen
The cornerstone of the diagnosis of neoplastic fever is the naproxen test.
A high proportion of patients with neoplastic fever (92%) has complete and sustained defervescence within 12–24 h of receiving naproxen. The most appropriate time to administer this test is after the results of initial evaluations in febrile patients have become available, a cause for the fever has not been revealed, and the fever has not responded to initial antibacterial/antifungal therapy. Defervescence on naproxen in this setting almost always indicates the presence of neoplastic fever, and discontinuation of anti-infective therapy is warranted. Naproxen and other nonsteroidal anti-inflammatory drugs have been effective in the management of neoplastic fever and offer a significant palliative benefit for the patient.
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Zell A., Chang C. Neoplastic fever: a neglected paraneoplastic syndrome. Support Care Cancer (2005) 13: 870–877. Internet. Accessed December 08, 2010.