Complex partial status epilepticus presenting as fever of unknown origin

A woman experienced multiple attacks of fever, each lasting 24 to 72 hours, over 1 1/2 years. The patient herself could not relate details of most episodes; her husband reported observing extreme prostration and incoherence during some of the episodes. A thorough investigation at three medical centers failed to reveal any of the usual causes of fever of unknown origin. Finally, another family member observed a sudden loss of responsiveness without loss of consciousness, blank staring, and repetitive arm movements. A diagnosis of complex partial status epilepticus was made, and fever was documented in association with repetitive complex partial seizures on two occasions in the hospital. Both the fever and the seizures were controlled by anticonvulsant medication, and both recurred under observation when the medication was discontinued. A review of the charts of adult patients admitted to the hospital for a primary neurologic disorder showed that those with epilepsy were more likely to experience fever within the first 24 hours than those without epilepsy (13 of 29 vs five of 29) especially if multiple seizures occurred. Fever may occur in association with seizures; occasionally it may be a presenting manifestation.