What medical conditions present with fever as a symptom?

Medical Conditions Presenting with Fever

Fever is a symptom of hundreds of medical conditions spanning infectious, inflammatory, neoplastic, drug-induced, and metabolic etiologies. The following comprehensive list organizes conditions by category based on clinical guidelines and systematic reviews.

Infectious Diseases

Respiratory Infections

• Influenza presents with fever (typically 38-40°C), cough (85%), headache (65%), myalgia (53%), and malaise (80%), with fever peaking within 24 hours and lasting 1-5 days 1
• Acute bronchitis is common, particularly in elderly patients and those with chronic medical conditions 1
• Primary viral pneumonia occurs within 48 hours of fever onset 1
• Secondary bacterial pneumonia typically develops 4-5 days after illness onset 1
• Sinusitis, pharyngitis, tonsillitis are common upper respiratory infections causing fever 1
• Tuberculosis presents with fever and respiratory symptoms, particularly in patients from endemic areas 1
• Melioidosis (Burkholderia pseudomallei) causes fever with cavitatory pneumonia or septicemia in patients from South East Asia 1
• Coccidioidomycosis occurs after dust or bat exposure in geographically restricted areas of the Americas 1

Tropical and Travel-Related Infections

• Malaria is a leading cause of fever in travelers, with 92% presenting with fever as primary complaint 1
• Dengue fever presents with fever (4-8 days incubation), headache, retro-orbital pain, myalgia, arthralgia, and rash; 78% present with fever 1
• Chikungunya causes fever (2-3 days incubation) with severe polyarthralgia 1
• Enteric fever (typhoid) presents with fever; 82% have fever as primary complaint 1
• Rickettsial infections including African tick bite fever (R. africae), Mediterranean spotted fever (R. conorii), murine typhus (R. typhi), and scrub typhus cause fever with headaches and myalgia 1
• Schistosomiasis (Katayama syndrome) presents 4-6 weeks post-exposure with fever, lethargy, myalgia, urticarial rash, and eosinophilia 1
• Yellow fever, Rift Valley fever, Congo Crimean hemorrhagic fever cause fever with potential hemorrhagic complications 1
• Japanese encephalitis, West Nile virus, tick-borne encephalitis present with fever and neurological symptoms 1

Gastrointestinal Infections

• Traveler's diarrhea causes fever in up to 30% of cases, commonly due to E. coli, Campylobacter, Salmonella, and Shigella 1
• Amoebic colitis presents with bloody diarrhea and fever with more indolent onset 1
• Viral hepatitis (A, B, E) causes flu-like febrile illness followed by jaundice and tender hepatomegaly 1

Bacterial Infections

• Brucellosis presents with fever (acute febrile illness with rigors to chronic relapsing fever), lymphadenopathy, hepatosplenomegaly, and osteoarticular complications 1
• Q fever (Coxiella burnetii) causes non-specific fever symptoms 1
• Diphtheria should be considered in travelers from endemic areas (former USSR, Indian subcontinent, South East Asia, South America) 1
• Anthrax requires source isolation when suspected 1
• Scarlet fever (Group A Streptococcus) presents with fever ≥38°C persisting at least 5 days, distinctive rash, sore throat, and cervical lymphadenopathy 2

Parasitic Infections

• Loeffler's syndrome (Ascaris, hookworm, Strongyloides) causes fever with pulmonary infiltrates and eosinophilia 1
• Tropical pulmonary eosinophilia (filaria) presents with fever, respiratory symptoms, and eosinophilia 1
• Visceral leishmaniasis causes double quotidian fever pattern 3

Other Infections

• HIV seroconversion presents as febrile illness 1
• Otitis media is common, particularly in children 1
• Parotitis is a rare complication of influenza 1

Cardiovascular Conditions

• Acute myocardial infarction can cause fever 4
• Dressler syndrome (post-MI pericarditis) presents with fever 4
• Myocarditis is a rare complication of influenza 1
• Pericarditis occurs rarely with influenza and can present with fever 1, 3
• Venous thrombosis and pulmonary infarction cause fever 4
• Endocarditis (including gonococcal) causes fever, particularly affecting the aortic valve in brucellosis 1, 3

Neurological Conditions

• Encephalitis/encephalopathy occurs within first week of influenza illness, more common in children 1
• Aseptic meningitis can present with fever, as seen in juvenile rheumatoid arthritis 3
• Transverse myelitis is a very rare complication of influenza 1
• Guillain-Barré syndrome is a very rare complication of influenza 1
• Intracranial bleeding and stroke can cause fever 4
• Nonconvulsive status epilepticus causes fever 4
• Central fever from hypothalamic dysfunction 4

Musculoskeletal Conditions

• Myositis occurs during early convalescence from influenza 1
• Myoglobinuria and renal failure are rare complications 1
• Juvenile rheumatoid arthritis (JRA) presents with fever, hepatosplenomegaly, and characteristic double quotidian fever pattern 3
• Adult Still's disease causes fever without specific diagnostic tests 3
• Gout can cause fever 4

Neoplastic Conditions

• Lymphoma and leukemia are important causes of fever of unknown origin, particularly in elderly patients 3
• Various malignancies account for significant proportion of FUO in elderly populations 3

Drug-Induced Fever

• Beta-lactam antibiotics (penicillins, cephalosporins) are the most common medication causes, typically occurring after 7-10 days (mean 21 days, median 8 days) 4, 5
• Antimicrobial-induced fever persists during drug administration and resolves within 1-3 days after discontinuation 4, 5
• Antipsychotic medications (phenothiazines, thioxanthenes, butyrophenones, amisulpride) cause fever through neuroleptic malignant syndrome or hypersensitivity 4, 5
• Drug withdrawal from alcohol, opiates, barbiturates, or benzodiazepines causes fever with tachycardia, diaphoresis, and hyperreflexia 4, 5

Endocrine and Metabolic Conditions

• Adrenal insufficiency causes fever 4
• Thyroid storm presents with fever 4
• Diabetes mellitus complications can worsen with influenza infection 1

Iatrogenic and Procedural Causes

• Blood product transfusion reactions cause fever 4
• Cytokine release syndrome causes fever 4
• Immune reconstitution inflammatory syndrome presents with fever 4
• Transplant rejection causes fever 4

Pulmonary Conditions

• Atelectasis can cause fever 4
• Acute respiratory distress syndrome (fibroproliferative phase) causes fever 4
• Pneumonitis without infection presents with fever 4

Toxic and Hyperthermic Syndromes

• Malignant hyperthermia causes severe fever 4
• Neuroleptic malignant syndrome requires immediate recognition and treatment 4, 5
• Serotonin syndrome causes fever 4
• Toxic shock syndrome is a rare complication of influenza 1
• Fat emboli cause fever 4

Autoinflammatory Diseases

• Various autoinflammatory syndromes present with recurrent fever as leading manifestation 6
• Genetic abnormalities of inflammasome functioning cause fever 7

Important Clinical Considerations

Fever Patterns

• Continuous, remittent, intermittent, and hectic fever patterns help narrow differential diagnosis 7
• Double quotidian fever (two peaks daily) is characteristic of visceral leishmaniasis, mixed malarial infections, gonococcal endocarditis, and JRA 3

Special Populations

• Elderly and immunocompromised patients may not present with fever despite severe infection 4, 8
• Children have higher rates of collagen vascular diseases and viral infections as FUO causes 3
• Pregnant women require special consideration for fever management 5

Diagnostic Pitfalls

• Uncommon manifestations of common diseases are more likely than rare diseases 9
• Non-infectious causes account for 0.5% of febrile illnesses in travelers but up to 35.5% of FUO cases in hospital populations 4
• Drug fever is a diagnosis of exclusion and should be considered when fever persists despite appropriate antibiotic therapy 4, 5