Non-Infectious Fever Associated with Massive Upper Gastrointestinal Bleeding

Fever is a common clinical manifestation often attributed to infection, which frequently leads to empirical antibiotic therapy. However, non-infectious causes of fever are easily overlooked. Among patients with gastrointestinal bleeding, a rare but under-recognised phenomenon known as absorption fever has been described. Increasing awareness of this condition is important to prevent unnecessary exposure to antibiotics.

A 61-year-old man presented with nausea, vomiting, epigastric pain and melaena. On admission, his temperature was 38°C. Laboratory tests revealed leucocytosis, anaemia and mildly elevated C-reactive protein levels. Computed tomography showed periduodenal fat stranding, and upper endoscopy demonstrated Los Angeles Grade D reflux oesophagitis along with multiple duodenal ulcers (Forrest IIa). Two sets of blood cultures were negative. An empirical single dose of cefmetazole was administered but discontinued on day 2 because no infectious source was identified. Supportive care, including transfusions, was provided. Despite persistent fever for four days, the patient's clinical condition remained stable. The fever resolved spontaneously without recurrence and repeat endoscopy on hospital day 12 confirmed mucosal healing. No evidence of infection was observed during hospitalisation.

This case illustrates a transient, non-infectious fever associated with massive upper gastrointestinal bleeding, consistent with absorption fever. Clinicians should recognise this underappreciated condition when evaluating febrile patients with gastrointestinal bleeding after carefully excluding infectious or malignant causes such as infectious colitis, inflammatory bowel disease, diverticulitis, enteric fever or gastrointestinal cancer.

Recognising non-infectious fever can prevent unnecessary antibiotic use, reduce adverse drug effects and support antimicrobial stewardship.

Fever in the setting of upper gastrointestinal bleeding may represent a non-infectious process, historically termed absorption fever, rather than an occult infection.Careful clinical, laboratory and imaging evaluation is crucial to distinguish non-infectious fever from infection and to guide appropriate management.Recognising absorption fever helps avoid unnecessary antibiotic use and supports antimicrobial stewardship, but only after serious infectious and inflammatory causes have been carefully excluded.