Fever of Unknown Origin in an Elderly Adult with Lipid Overload Syndrome

作者：Jinling Ma, Yutang Wang, Shifeng Zhao, Qingyi Meng, Yuanyu Qian · 发表于：Journal of the American Geriatrics Society · 年份：2012 · DOI：10.1111/j.1532-5415.2012.03911.x · 被引用次数：1 · 研究领域：Thermal Regulation in Medicine、Hematological disorders and diagnostics、Sepsis Diagnosis and Treatment

Fever of unknown origin (FUO) is a challenging medical problem. An important cause of FUO is drug fever.1 Lipid emulsions have become an important component of parenteral nutrition2 and are used to provide additional calories and prevent free fatty acid deficiency, but excessive fat infusions can cause hypertriglyceridemia and fat overload; overfeeding macronutrients to critically ill patients can negatively affect organ function, particularly the lungs, liver, and kidneys.3 This study discusses an individual who developed FUO according to the definition by Petersdorf and Beeson4 because of intralipid administration in lipid overload syndrome. A 92-year-old man with a tracheal incision who was on mechanical ventilation received total parenteral nutrition because of his severe reflux esophagitis. A subclavian vein catheter was placed, and total parenteral nutrition was initiated with 10% invert sugar, 5% compound amino acid injection, 250 mL of 10% medium and long fat emulsion injection, and 100 mL of omega-3 fish oil fat emulsion injection per day. At the time of initial therapy, laboratory studies showed that white blood cell count and differential and liver and renal function were within the normal range. On Day 11, the patient experienced a fever, with the highest temperature at 38.3°C. C-reactive protein (CRP) and lactic dehydrogenase (LDH) levels, white blood cell count, and neutrophils began to rise. Tests including chest X-ray and abdominal ultrasonography at bedside w...