[Is the indomethacin test able to indicate the etiological diagnosis of isolated fever?]
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Published on: February 11, 2011
J Barrier1, P Roblot, A Ramassamy
1Service de médecine interne et maladies infectieuses, CHU La Milétrie, Poitiers, France.
Abstract:
The aim of this study was to determine if evolution of fever after administration of indomethacin to febrile patients could separate those with fever of infectious origin from those with non-infectious origin. All patients with a rectal body temperature superior than 38 degrees C for at last 5 days and without any antibiotic or antipyretic therapy for more than 48 hours, were included in a 1 year prospective study. Each patient received one time 50 mg of indomethacin and rectal body temperature was obtained every 3 hours for 12 hours. Forty-five patients were included, 20 in group I (fever of infectious origin) and 25 in group II (fever of non-infectious origin). The mean age and mean initial body temperature were similar in the two groups. After administration of indomethacin, mean duration and mean amplitude of abatement of fever were similar in the two groups. Hypothermia was observed more frequently in group II (28%) than in group I (10%) (p < 0,05) and was preferentially associated to a malignant lymphoma. Also, diagnostic procedure with indomethacin is of little interest to separate fever of infectious origin from other, but hypothermia would suggest a fever due to a malignant lymphoma.
Insights
Indomethacin administration did not reliably distinguish infectious from non-infectious fever origins. However, hypothermia after indomethacin may suggest a fever linked to malignant lymphoma.
Area of Science:
- Internal Medicine
- Pharmacology
Background:
- Fever of unknown origin presents diagnostic challenges.
- Differentiating infectious from non-infectious causes is crucial for appropriate treatment.
Purpose of the Study:
- To evaluate indomethacin's utility in differentiating infectious from non-infectious fevers.
- To assess fever response patterns following indomethacin administration.
Main Methods:
- Prospective study of 45 febrile patients (temperature >38°C for ≥5 days).
- Single 50 mg indomethacin dose administered.
- Rectal body temperature monitored every 3 hours for 12 hours.
Main Results:
- No significant difference in fever duration or amplitude abatement between infectious and non-infectious groups.
- Hypothermia occurred more frequently in the non-infectious group (28% vs 10%).
- Hypothermia was associated with malignant lymphoma.
Conclusions:
- Indomethacin is not a reliable diagnostic tool for distinguishing infectious from non-infectious fevers.
- Indomethacin-induced hypothermia may indicate a malignant lymphoma as the fever source.
