Occult dental infection causing fever in renal transplant patients

Fever secondary to odontogenic infection following successful renal transplantation is reported in three patients. All three patients initially lacked signs or symptoms localizing to the oral cavity, and two of the three patients did not have x-ray evidence of abscess formation. Two patients received antibiotic therapy without any apparent clinical response, and all three patients responded promptly to surgical extractions. Our patients illustrate that fever can be the only sign of dental sepsis in renal transplant recipients, and tooth extraction as empiric therapy may be necessary. Most important, however, is that the dental pathology responsible for their fever could have been detected and treated prior to transplantation. We recommend pretransplant dental evaluation of all patients with extraction of partially impacted molars and treatment of all periodontal disease and dental caries.