eMedicine Specialties > Oncology > Special Topics in Oncology

Pel-Ebstein Fever: Treatment & Medication

Author: Ephraim P Hochberg, MD, Instructor in Medicine, Cancer Center, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Jun 26, 2006

Treatment

Medical Care

  • Therapy for Pel-Ebstein fever involves the following 2 concepts:
    • Standard antipyretic regimens, including aspirin and nonsteroidal anti-inflammatory drugs
    • Most importantly, chemotherapy for the underlying lymphoma
  • Pel-Ebstein fever reportedly responds to chemotherapy within as short as 2 days.

Surgical Care

Surgery is not indicated.

Consultations

Consulting a hematologist or oncologist for the management of the underlying HL is mandatory.

Diet

Diet modification is ineffective in the therapy for Pel-Ebstein fever.

Activity

Activity restriction does not play a role in treatment of Pel-Ebstein fever.

Medication

Antipyretic therapy and chemotherapy for the underlying lymphoma are the 2 mainstays of medical therapy for Pel-Ebstein fever. Treatment of the underlying lymphoma or Hodgkin lymphoma (HL) is beyond the scope of this discussion (see Hodgkin Disease).

Antipyretic agents

These agents are used to reduce uncomfortable fevers.


Acetaminophen (Tylenol)

Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

Adult

325-1000 mg PO q4h prn; not to exceed 4 g/d

Pediatric

10-15 mg/kg/dose PO q4-6h; not to exceed 5 doses/d

Rifampin can reduce analgesic effects; barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Hepatotoxicity possible in chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate serious illness; acetaminophen is contained in many OTC products, and combined use with these products may result in cumulative doses exceeding recommended maximum dose

More on Pel-Ebstein Fever

Overview: Pel-Ebstein Fever
Differential Diagnoses & Workup: Pel-Ebstein Fever
Treatment & Medication: Pel-Ebstein Fever
Follow-up: Pel-Ebstein Fever
References
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References

  1. Colvett KL, Patel D, Smith JK. Multiple Beau''s lines in a patient with fever of unknown origin. South Med J. Dec 1993;86(12):1424-6. [Medline].

  2. Dankbaar H, Willemze R, Bieger R. Bone marrow disorders in Hodgkin''s disease: cyclic pancytopenia coinciding with Pel-Ebstein fever. Neth J Med. 1983;26(3):74-6. [Medline].

  3. Good GR, DiNubile MJ. Images in clinical medicine. Cyclic fever in Hodgkin''s disease (Pel- Ebstein fever). N Engl J Med. Feb 16 1995;332(7):436. [Medline].

  4. Hilson AJ. Pel-Ebstein fever [letter; comment]. N Engl J Med. Jul 6 1995;333(1):66-7. [Medline].

  5. Koopmans RP, van den Born BJ, Kersten MJ, Hart W. [Clinical reasoning and decision making in practice. A 41-year old with periodic fever of unknown origin]. Ned Tijdschr Geneeskd. Sep 13 2003;147(37):1778-83. [Medline].

  6. McKenna W, Lampert I, Oakley C, Goldman J. Pel-Ebstein fever coinciding with cyclical haemolytic anaemia and splenomegaly in a patient with Hodgkin''s disease. Scand J Haematol. Nov 1979;23(5):378-80. [Medline].

  7. Molina Boix M, Ortega Gonzalez G, Garcia Perez B, Perez Gracia A. [Pel-Ebstein fever, hemolytic anemia and Hodgkin''s disease (letter)]. An Med Interna. Jul 1989;6(7):388-9. [Medline].

  8. Racchi O, Rapezzi D, Ferraris AM, Gaetani GF. Unusual bone marrow relapse of Hodgkin''s disease with typical Pel- Ebstein fever. Ann Hematol. Jul 1996;73(1):39-40. [Medline].

  9. Reimann HA. Periodic (Pel-Ebstein) fever of lymphomas. Ann Clin Lab Sci. Jan-Feb 1977;7(1):1-5. [Medline].

  10. Storgaard L, Karle H. Fever and haemolysis in Hodgkin''s diseases. Acta Med Scand. Apr 1975;197(4):311-6. [Medline].

  11. Talbot TR. Cases from the Osler Medical Service at Johns Hopkins University. Hodgkin''s disease with Pel-Ebstein fevers. Am J Med. Mar 2002;112(4):312-3. [Medline].

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Further Reading

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Keywords

Pel-Ebstein fever, periodic fever of lymphomas, Hodgkin disease, Hodgkin's disease, HD, Hodgkin's episodic fever, Hodgkin episodic fever, B symptoms, B-type symptoms, Hodgkin lymphoma, Hodgkin's lymphoma, HL, lymphoma, lymphoma-related fever, relapsing fever, hemolysis, hemolytic anemia, periodic fever spikes

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Contributor Information and Disclosures

Author

Ephraim P Hochberg, MD, Instructor in Medicine, Cancer Center, Massachusetts General Hospital
Ephraim P Hochberg, MD is a member of the following medical societies: American Society of Clinical Oncology and American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey M Zaks, MD, Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital
Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veteran's Administration Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

John S Macdonald, MD, Professor of Medicine, New York Medical College; Chief, Division of Medical Oncology, St Vincent's Hospital and Medical Center; Medical Director, Saint Vincent's Comprehensive Cancer Center
Disclosure: Nothing to disclose.

 
 
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