Drug fever due to piperacillin/tazobactam loaded into bone cement

Area of Science:

• Pharmacology
• Infectious Diseases
• Orthopedic Surgery

Background:

• Drug fever is a common adverse drug reaction, typically associated with systemic drug administration.
• Antibiotic-loaded bone cement is widely used in orthopedic surgery to prevent and treat bone infections.
• Previous literature has not reported drug fever specifically linked to antibiotic-loaded bone cement.

Observation:

• A 72-year-old female patient developed fever, skin rash, and blood eosinophilia two weeks post-knee joint surgery.
• The patient had received antibiotic-loaded bone cement containing piperacillin/tazobactam for infectious arthritis.
• Extensive work-up ruled out other common causes of fever.

Findings:

• A drug provocation test confirmed piperacillin/tazobactam, incorporated into the bone cement, as the causative agent for the drug fever.
• This case represents the first documented instance of drug fever induced by piperacillin/tazobactam within bone cement.
• The patient's symptoms resolved after discontinuation of the implicated antibiotic.

Implications:

• This case suggests that any systemically absorbed drug, regardless of administration route (including local delivery via bone cement), can potentially induce drug fever.
• Clinicians should consider drug fever in the differential diagnosis for patients presenting with unexplained fever after orthopedic procedures involving antibiotic-loaded bone cement.
• Comprehensive drug history, including locally administered agents, is crucial for accurate diagnosis of drug fever.