Sporadic fever in an oncological patient

A 45-year-old woman had a diagnosis of breast cancer. She started two months after finishing chemotherapy with dyspnea and thoracic pain and a plain X-ray showed the presence of pleural effussion on the right side and some pleural and intrapulmonar nodes compatible with metastases. The first day at the hospital she had mild fever after a thoracocentesis procedure followed by normal temperature in the next days until a new abrupt increase of temperature…

CLINICAL CASE: Physical examination detected hypoventilation on the basal right lung. No other signs or symptoms were detected . No rash or skin lesions.

CLINICAL EVOLUTION: The patient improved after thoracocentesis but the tube had to be relocated in two ocassions. One night she started with chills and high-fever and a sample for blood culture was taken and she started with empirical antibiotics. The blood culture was positive for a bacteria covered by the antibiotic.

A new blood sample extracted from peripheral blood was negative, but this time a sample from a Port-A-Cath showed the presence of a new bacteria. The device was removed and a new peripheral blood culture was negative.

COMMENTS:

. Initially all the attention was directed to the pleural effussion. The presence of mild fever was related with the procedure of thoracocentesis.

. The Port-A-Cath device is a “red point” in Oncology when fever is present but usually is a “sporadic” or intermitent fever related with the manipulation. Sometimes it is difficult to recognize a pattern because this manipulation ocurred every three or four weeks.

. There was some kind of “satisfaction” after the diagnosis of pleural effussion and the plausible relation of fever with thoracocentesis.