Antibiotic-induced Fever in a post-operative Patient—A Diagnostic Challenge
Aditya Yawalikar, Shruti Jeyakumar, Raseeka Subramanian and Sanjay Chatterjee*
Department of General Surgery, Bombay Hospital Institute of Medical Sciences, India
*Corresponding Author: Sanjay Chatterjee, Associate Professor, Department of General Surgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
Published: July 03, 2025
DOI: 10.55162/MCMS.09.302
Abstract
Postoperative fever is a common clinical challenge, and its etiology varies with the timing of onset. While infectious causes dominate the differential diagnosis, non-infectious etiologies such as drug- induced fever must not be overlooked, especially when clinical findings are inconclusive.
We report the case of a 43-year-old male with a prior diagnosis of appendiceal adenocarcinoma, who underwent a completion right hemicolectomy following an open appendicectomy. The early postoperative period was uneventful until postoperative day (POD) 5, when the patient developed intermittent fever spikes. Extensive workup—including laboratory investigations, imaging, and clinical examination—failed to identify any infective focus. A temporal correlation was noted between the administration of intravenous cefuroxime and the onset of fever. Discontinuation of the antibiotic on POD-7 led to complete resolution of symptoms, confirming the diagnosis of cefuroxime-induced drug fever.
Drug-induced fever, particularly due to β-lactam antibiotics like cefuroxime, remains an underrecognized yet significant postoperative complication. Characterized by a lack of systemic toxicity and resolution upon drug cessation, it should be considered when infectious causes have been ruled out. Awareness of this phenomenon is crucial to avoid unnecessary investigations and prolonged antibiotic use.
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