Factitious fever (FF) is one of the possible presentations of chronic factitious illness. Factitious fever is further categorized as one of the possible causes of fever of unknown origin (FUO). FF can be caused by a range of psychiatric and non-existing illnesses, namely Munchausen syndrome, Munchausen syndrome by proxy, malingering, and various personality disorders. The patients with FF may present with atypical symptoms of a certain disease and may appear to be genuinely ill. They may deliberately falsify their history and tamper with physical findings to achieve this. This may be done for a number of reasons, such as in order to gain attention from health professionals. Individuals with FF may also change their hospital or caregivers frequently.

Of note, FF occurs more commonly among individuals with a medical background such as medical students, nurses, pharmacists, and laboratory technicians. One proposed explanation is that it is easier for them to gain access to medical supplies, as well as to garner attention from their colleagues.

There are a number of ways in which FF can be created and these include manipulation of thermometers to show a higher reading, infecting oneself using various contaminants, and taking drugs that raise body temperature [1] [2]. Self-induced infection may additionally result in recurrent episodes of skin and soft tissue infections such as cellulitis and abscesses or bacteremia that is poly-microbial. The isolated organisms could include Streptococcus viridans, Pseudomonas aeruginosa, and microbes found in fecal matter.

Other clues of FF are reported fever with no other systemic signs such as tachycardia or skin that is unusually warm to touch. FF may be a difficult diagnosis to make as FUO is in itself a challenge to clinicians [3]. FF is, however, one of the most prominent causes of FUO [4].

• Fever

  An artificial fever may be suspected if the pulse rate is much less than expected for the degree of fever noted. This diagnosis should be considered in all patients in whom there is no other plausible explanation for the fever. [medical-dictionary.thefreedictionary.com]

  Bennett IL: The significance of fever in infections, Yale J. Biol. and Med. 26: 491, 1954. MedlineGoogle Scholar 4. Beeson PB: Fever in Signs and symptoms: applied pathologic physiology and clinical interpretation, C. M. [acpjournals.org]

  Factitious fever (FF) is one of the possible presentations of chronic factitious illness. Factitious fever is further categorized as one of the possible causes of fever of unknown origin (FUO). [symptoma.com]

  (c) Drugs can also produce fever. [jpma.org.pk]

  A retrospective study identified 2.2 per cent (11 of 506) of all patients whose fever on their charts was coded as fever of undetermined origin as having factitious fever. [ncbi.nlm.nih.gov]

• Rigor

  • 33 years old diabetic female present with fever of (39.5°C) for 3 days associated with rigor and loin pain. • 18 years old female presented with fever ranging (38.5°C -39.7°C) for 1 month duration, with previous history of multiple hospital admissions [studyslide.com]

  Prostatitis - urinary symptoms, lower back pain, recent UTI or STI, catheterisation Malaria - Travel and exposure to insect bite (mosquito), recurring or intermittent fever, chills and rigors Rickettsial infections - travel and exposure to insect bite [fastbleep.com]

• Denial

  However, as no clear structured methods are available to diagnose the FD and no clear guidelines are available to confront, precautionary methods need to be taken to avoid untoward outcomes like absconding and denial for follow-up. [ijpm.info]

• Infantile Paralysis

  †Fellow of the National Foundation for Infantile Paralysis. Requests for reprints should be addressed to Robert G. Petersdorf, M.D., The Johns Hopkins Hospital, Baltimore 5, Maryland . [acpjournals.org]

Factitious fever should be approached with possible comorbidities and complications in mind. Possible complications of self-induced infection include bacterial endocarditis and septic pulmonary emboli. Psychiatric evaluation of the patient should also be carried out in the presence or absence of psychiatric symptoms, especially in chronic or repeated illness.

A thorough history and physical examination are instrumental in excluding possible causes of the fever [5] [6]. Routine laboratory tests such as complete blood count (CBC), inflammatory markers, metabolic panel, urinalysis, and blood and urine cultures should be carried out. In addition, various imaging modalities, such as chest X-rays and ultrasound, may also be carried out at the clinician's discretion. Computed tomography (CT) and magnetic resonance imaging (MRI) scans may be incorporated as the next step in the investigation.

[…] resulting either from the production of illness or from the performance of unnecessary tests or treatments If the patient is receptive to psychiatric treatment, patient education may be an important component of psychotherapy. [emedicine.medscape.com]

Treatment approach Medical and surgical treatments should be provided as needed to treat comorbidities and complications resulting from factitious disorder, malingering, and somatoform disorders. [cancertherapyadvisor.com]

Prompt detection not only spares patients prolonged hospitalization and unwarranted treatment and procedures, but more important, it allows appropriate psychiatric care to be offered.2,3 Since early detection can be viewed as the clinician's primary responsibility [jamanetwork.com]

No clearly effective treatments Treatment of factitious disorder imposed on self is usually challenging, and there are no clearly effective treatments. [msdmanuals.com]

The primary treatment for Factitious Disorder is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). [clevelandclinic.org]

Exceptions: empiric steroids for suspected GCA or empiric abx in neutropenic patients Prognosis Depends on age and etiology of FUO (worse with elderly and malignancy as etiology) Most without Dx after extensive evaluation have good prognosis with low [utswim.wordpress.com]

These patients generally have a good prognosis, with resolution of fever in several months. [ime.acponline.org]

Therapy is adjusted after a diagnosis is made.[3] Prognosis[edit] Since there is a wide range of conditions associated with FUO, prognosis depends on the particular cause.[1] If after 6 to 12 months no diagnosis is found, the chances diminish of ever [en.wikipedia.org]

Prognosis The more chronic and severe Munchausen variant of factitious disorder appears to follow an unremitting course, and the prognosis is generally poor. [emedicine.medscape.com]

Prognosis- The patient's prognosis is dependent on the underlying disease process and by how soon a diagnosis is obtained. Outcomes are worse for neoplasms. [atsu.edu]

The authors define an unexplained fever as a fever which lasts a minimum of 14 days and whose etiology is not known. [books.google.com]

Excerpt The problem of elucidating the etiology of fever is one of the most fascinating and challenging that confronts the physician. [acpjournals.org]

Epidemiology Classic FUO etiologies fall into 5 major categories: Infection, Malignancy, Inflammatory, Miscellaneous, Unknown Distribution depends on decade, patient age, geography, and type of practice Etiology Infections Tuberculosis (extrapulmonary [utswim.wordpress.com]

Abstract The task of elucidating the etiology of fever of undertermined origin remains a major undertaking. [ncbi.nlm.nih.gov]

Classification of Fever of Unknown Origin (FUO) Category of FUO Definition Common etiologies Classic Temperature >38.3°C (100.9°F) Duration of >3 weeks Evaluation of at least 3 outpatient visits or 3 days in hospital Infection, malignancy, collagen vascular [medicalcriteria.com]

Sweeping updates include new or revised chapters on: Hepatitis C and antivirals Fungal infection and newer antifungals Microbiome and infectious diseases as well as advances in diagnosis of infection; Clostridium difficile epidemiology; infection control [books.google.com]

Epidemiology Classic FUO etiologies fall into 5 major categories: Infection, Malignancy, Inflammatory, Miscellaneous, Unknown Distribution depends on decade, patient age, geography, and type of practice Etiology Infections Tuberculosis (extrapulmonary [utswim.wordpress.com]

International statistics Whether the epidemiology of factitious disorder differs in countries other than the United States is unclear. [emedicine.medscape.com]

RF, ANA, other inflammatory antibodies serology, according to local epidemiology HIV tuberculosis CMV EBV biopsy (liver, bone marrow) Diagnostic Imaging Imaging should initially include: chest X ray abdominal and pelvic ultrasound Other modalities could [sharinginhealth.ca]

[…] has also been a case report on concurrent presence of FD and FD by proxy. [5] Another newer concept or problem in this field is "Munchausen by Internet," where a person may post false stories of his illness on internet forums to gain attention. [6] Epidemiology [ijpm.info]

This book covers pathophysiology of fever, the general approach to the febrile patient, and offers a systematic, in-depth discussion regarding the differential diagnosis of unexplained fever. [books.google.com]

[…] labeled immunoglobulins, and 18-fluoro-deoxy-glucose. return to top Management If no causes are identified after work-up, a number of options are possible: watchful waiting inflammation tracer scintigraphy staged approach therapeutic trials return to top Pathophysiology [sharinginhealth.ca]

Pathophysiology The pathophysiology of factitious disorder has not been determined. No causative brain defect or dysfunction has been identified. A study of 5 cases suggested neurocognitive deficits. [emedicine.medscape.com]

The tenth issue in our growing online database, edited by James Newman, covers essential updates in the following topics: Long QT; Noninvasive ventilation; Fever of Unknown Origin; Post Bariatric Surgery; Hospital Fall Prevention; Mimics of Cellulitis [books.google.de]

Prevention Although FUO cannot actually be prevented because the sources are unknown, the immune system can be strengthened to help avoid infection from bacteria, viruses, and toxins. [healthofchildren.com]

It is also important to drink enough liquids, to prevent dehydration. Familial Mediterranean fever (Medical Encyclopedia) Fever (Medical Encyclopedia) When your baby or infant has a fever (Medical Encyclopedia) [ Read More ] [icdlist.com]

Better understanding and identification of these children is likely to help prevent the development of more chronic adult factitious disorders. factitious disorder Munchausen by proxy children adolescents factitious illness Received January 19, 1999. [pediatrics.aappublications.org]

‘a largely factitious national identity’ ‘First, by so doing, he could secure a factitious glory at home; this would prevent or, at least, postpone the rise of a new opposition.’ [en.oxforddictionaries.com]

1. Aduan RP, Fauci AS, Dale DC, Herzberg JH, Wolff SM. Factitious and self- induced infection; a report of 32 cases and review of literature. Ann Intern Med. 1979;90:230–242.
2. Gershwin ME, Gude JK, Petralil J. Factitious Subcutaneous Emphysema. Ann Intern Med. 1971;75:585–587.
3. Petersdorf RG. Fever of unknown origin. An old friend revisited. Arch Intern Med. 1992;152(1):21-22.
4. Barbado FJ, Vázquez JJ, Peña JM, Arnalich F, Ortiz-Vázquez J. Pyrexia of unknown origin: changing spectrum of diseases in two consecutive series. Postgrad Med J. 1992;68(805):884-887.
5. Hayakawa K, Ramasamy B, Chandrasekar PH. Fever of unknown origin: an evidence-based review. Am J Med Sci. 2012;344(4):307-316.
6. Sipahi OR, Senol S, Arsu G, et al. Pooled analysis of 857 published adult fever of unknown origin cases in Turkey between 1990–2006. Med Sci Monit. 2007;13(7):CR318-322.