Medical Student Corner
Case Studies: Fever

A woman in her mid-thirties was brought by her husband to the Emergency Department with a chief complaint of fever.

This was her fifth such ED visit for this symptom during a period of three months; previous evaluations were noted to have been unrevealing.

The patient appeared to be confused and disoriented, and was unable to provide an adequate history.

Her husband seemed extremely concerned, and became visibly distraught when discussing her condition.

"I never knew how much she loved me," he stated, adding, "Never knew how much she cared."

He then related how even "putting my arms around her" resulted in her developing a "fever that's so hard to bear."

"Fever!," he exclaimed, "fever when I kiss her; fever when I hold her tight!"

He additionally noted fever in the morning, and fever all through the night.

Past medical and surgical history, medications, allergies, smoking & alcohol history, review of systems, and family history were all negative or non-contributory. Menses were normal and regular.

Examination revealed a temperature of 101.1 FM, "Your Rockin' Oldies Station," but was otherwise unremarkable.

What's the diagnosis?

Comment by John Davenport, MD*:

There are a great many causes of fever, the majority of which can be classified in the general categories of infectious, collagen-vascular / autoimmune, and neoplastic. Less common causes include such causes as Familial Mediterranean Fever, and sarcoid.

This young woman shows no signs or symptoms of any of these conditions. Furthermore, the results of previous fever work-ups have been negative, suggesting that extraordinary circumstances may be involved.

The history of mutiple ED visits in a short period of time for the same complaint, always accompanied by her husband, is also suspicious.

Upon further probing, the patient's husband, an unemployed actor, admitted that he enjoyed the attention he received from the hospital staff as he recounted the details of his wife's illness. He went on further to say that he elicited her fevers by playing classic Barry White and Luther Vandross records, which have been clinically proven to induce fever in over 65% of women in this patient's age group.

Obtaining psychological gain in such a fashion at another's expense is the hallmark of Munchausen's By Proxy.

In closing, everybody's got the fever. That is something you all know - fever isn't such a new thing: fever started long ago.

*Dr. John Davenport is not really a doctor, but he did write the song "Fever" with Eddie Cooley. Neither Mr. Davenport nor Mr. Cooley have had anything really to do with this article. Other than writing the song, that is.