647. Diagnoses Associated with Temperature ≥104°F in Adults

Abstract

Background. Temperature >=104degreeF (T >= 104) is uncommon in adults. The diagnoses and clinical characteristics were reviewed for patients with T >= 104. Methods. Infectious disease physicians reviewed charts of patients with T >= 104 seen at the Washington DC Veterans Affairs Medical Center from 2009 to 2018. The following was collected: demographics, past medical history, medications, WBC, maximum temperature, time to defervescence, etiology of T >= 104, and death. Results. Less than 0.01% of all patient encounters were associated with T >= 104. Of the 60 most recent patients with T >= 104 (from 2014 to 2018), the median age was 63.5 years (range 23-97), 65% were African American, 88% were male. 82% of those with T >= 104 were hospitalized; 76% of those had the T >= 104 on or within 72 hours of admission. 25% of the 60 patients had underlying cancer, 10% HIV, 30% DM, 13% CKD, and 13% were on steroids/immunosuppressants/biologics. The median peak temperature was 104.3degreeF (interquartile range 104.0 -104.7); maximum was 106.8degreeF. 82% had T >= 104 for only 1 day and the median time to defervescence was 2 days. There were 55 diagnoses amongst 48 patients 12 had no identifiable etiology of T >= 104. Of the identifiable diagnoses, there were 45 (81.8%) infections, 4 (7.3%) metastatic malignancies (1 Hodgkin's lymphoma, 1 small cell carcinoma, 1 squamous cell carcinoma, 1 unknown primary), 2 (3.6%) intracranial bleeds, 2 (3.6%) GI bleeds, 1 (1.8%) mixed collagen vascular disease, and 1 (1.8%) neuroleptic malignant syndrome. The most common infections were 15 cases of pneumonia including 2 Legionella, 8 complicated UTI/pyelonephritis, 3 primary bacteremia, 2 West Nile virus, 2 influenza, and 2 cholangitis with bacteremia. The median WBC of infectious diagnoses (9.8) was significantly higher than noninfectious diagnoses (5.8, P = 0.006, T-test). Of the 60 patients, 20% died within 30 days of T >= 104 including 2 patients who died of sepsis. 67% of those who died were receiving hospice care. Conclusion. T >= 104 is rare in adults and is usually associated with bacterial infections such as pneumonia (including Legionella), complicated UTIs/pyelonephritis, and primary bacteremia but may also be seen with viral infections such as West Nile virus and influenza. Mortality is high.