From the Research
Fever after a pulmonary embolism (PE) can be caused by the inflammatory response to the clot itself, which typically lasts 1-3 days after diagnosis, as seen in a case report where a patient's high-grade fever resolved with anticoagulation 1. The PE itself can cause fever as part of this inflammatory response, involving cytokine release and neutrophil activation, which can raise body temperature as part of the normal healing process, but this should be self-limiting. If fever persists beyond this period or develops later, it may indicate complications such as infection, hematoma at injection sites, or drug reactions. For mild fever (below 38.5°C or 101.3°F) within the first few days after PE, acetaminophen (Tylenol) 650mg every 6 hours as needed is appropriate, based on general medical principles. However, for persistent or high-grade fever, medical evaluation is necessary to rule out complications, as emphasized in recent guidelines for the management of high-risk pulmonary embolism 2. Blood cultures, chest imaging, and examination of IV sites may be required to determine the cause of the fever and guide further treatment. It's essential not to assume fever is always due to the PE itself, especially if it persists beyond 72 hours, is accompanied by other symptoms like chills or productive cough, or if the patient is immunocompromised. The most recent and highest quality study on the intensive care treatment of pulmonary embolism highlights the importance of prompt diagnosis and management, as well as the need for risk stratification to guide therapeutic decision-making 2. In patients with high-risk PE, bedside diagnostics and drug-based haemodynamic stabilisation are crucial, and thrombolysis or catheter-based procedures may be necessary to eliminate or reduce pulmonary vascular thrombotic obstruction. Overall, the cause of fever after PE should be thoroughly investigated, and treatment should be guided by the underlying cause, with a focus on preventing complications and improving patient outcomes, as recommended in recent clinical guidelines 2.