From the Guidelines
Yes, a pulmonary embolism (PE) can cause fever, as it triggers an inflammatory response in the body, leading to the release of cytokines and other inflammatory mediators that can raise body temperature. According to the most recent guidelines, fever is not a specific symptom of PE, but it can occur in approximately 20-30% of patients with PE, typically presenting as a low-grade fever ranging from 100.4°F to 102.2°F (38°C to 39°C) 1. The clinical presentation of PE is non-specific, and symptoms can vary widely among patients, including dyspnoea, chest pain, presyncope or syncope, or haemoptysis 1.
Key Points to Consider
- Fever is not the most common symptom of PE, but it can be present in some cases
- More typical symptoms of PE include sudden shortness of breath, chest pain that worsens with deep breathing, rapid heart rate, and cough (sometimes with bloody sputum)
- If someone with a diagnosed PE develops a high fever (above 102.2°F or 39°C), this might indicate an additional complication such as an infection rather than just the PE itself
- Prompt diagnosis and treatment with anticoagulants (blood thinners) are essential to prevent serious complications in patients with PE 1
Importance of Prompt Medical Attention
It is crucial for anyone experiencing symptoms suggestive of a PE to seek immediate medical attention, as prompt diagnosis and treatment can significantly improve outcomes and reduce the risk of serious complications, including morbidity, mortality, and decreased quality of life 1. The 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism emphasize the importance of considering the clinical probability of PE, which increases with the number of predisposing factors present, and highlight the need for a thorough diagnostic workup to confirm the diagnosis and guide treatment decisions 1.
From the Research
Presentation of Pulmonary Embolism
- Pulmonary Embolism (PE) can manifest with various clinical symptoms, including fever 2, 3, 4.
- The frequency and severity of fever in acute PE have been evaluated in several studies, indicating that low-grade fever is not uncommon in PE, and high fever, although rare, may occur 2, 4.
Fever in Pulmonary Embolism
- A study published in the journal Chest found that among patients with angiographically proven PE and no other source of fever, fever was present in 14% of patients 2.
- Another study published in Blood Coagulation & Fibrinolysis found that at presentation, fever without other identified causes was present in 18.2% of patients with acute PE, with 27 patients having low-grade fever and one patient having high-grade fever 4.
- A case report published in Medicine described a rare case of a saddle pulmonary embolism presenting with high-grade fevers, responsive to anticoagulation 3.
Clinical Implications
- The presence of fever in PE does not necessarily indicate pulmonary hemorrhage or infarction 2.
- Clinical evidence of deep venous thrombosis is often present in patients with PE and otherwise unexplained fever 2.
- Fever should be considered as a possible presenting feature in patients with acute PE, and patients with acute PE and fever have similar characteristics compared with those without fever 4.