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

  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]

  factitious fever Fever produced artificially by a patient. [medical-dictionary.thefreedictionary.com]

  • To be able to have a plan to approach a patient with Fever when the basic clinical and laboratory tests did not reveal much as to the cause of fever Fever of unknown origin (FUO) :is a sustained, unexplained fever despite a comprehensive diagnostic [studyslide.com]

  Factitious Fever Pages with reference to book, From 189 To 191 Factitious fever is one of the causes of fever of unknown origin. [jpma.org.pk]

• Laboratory Technician

  Of note, FF occurs more commonly among individuals with a medical background such as medical students, nurses, pharmacists, and laboratory technicians. [symptoma.com]

  Factitious Fever is more common amongst medical and paramedical staff e.g. nurses, pharmacists, bacteriologist, laboratory technicians and medical students, because of their familiarity with the hospital, easy access to thermometers and drugs and because [jpma.org.pk]

• 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]

• Camping

  It induces neurotransmitters such as cAMP to reset the body's temperature set-point. This causes fever, somnolence, and lethargy. It also explains how NSAIDs and acetominophen are antipyrogenic. [sharinginhealth.ca]

  Chambers E, Yager J, Apfeldorf W, Camps-Romero E. Factitious aortic dissection leading to thoracotomy in a 20-year-old man. Psychosomatics. Jul-Aug 2007;48(4):355-358. Hopkins RA, Harrington CJ, Poppas A. [nzma.org.nz]

• Rectal Bleeding

  Seijffers, M.J. and Weiner, A. (1969) Massive rectal bleeding in a malingering patient. Dis. Colon Rectum, 12 : 347. 36. [jpma.org.pk]

• 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]

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.

• Cryptococcus Antigen

  antigen, histoplasmosis, coccidioidomycosis) • Protozoal and parasitic (toxoplasmosis, amoebiasis, schistosomiasis, leishmaniasis, trypanosomiasis) • PCR e.g for tuberculosis, herpes simplex virus (HSV), CMV, HIV, erythrovirus, dengue, Toxoplasma, Whipple's [studyslide.com]

• Chlamydia Trachomatis

  trachomatis infection; acquired syndromes associated with autoantibodies to cytokines;; management of multidrug resistant pathogens; probiotics, polymyxins, and the pathway to developing new antibiotics HIV including HIV and aging, antiretroviral therapy [books.google.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.