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This new book on fever was edited by Philip Mackowiak, chief of the medical service at the Veterans Administration Hospital in Baltimore. Dr Mackowiak has written three chapters himself—on drug fever, on the effects of pathogenic organisms (mostly bacteria), and on the influence of fever on pharmacokinetics and pharmacodynamics. All three chapters have appeared elsewhere as reviews. They have been somewhat expanded and reedited, and may have served as a stimulus for this book. The first few chapters are clearly written, scholarly reviews dealing with basic mechanisms of fever. Charles Dinarello's chapter on endogenous pyrogens starts with a historical overview and brings the reader right up to date with newer knowledge about the role of cytokines. The chapter is supported by 188 excellent references. Other chapters in this section cover thermoregulation, exogenous pyrogens, and prostaglandins. Further on there is another excellent chapter on antipyretics written by Wesley Clark. It has

DRUG FEVER as the only manifestation of isoniazid intolerance is uncommon. In one series, fever without other evidence of hypersensitivity developed in only five of 1,724 hospitalized patients treated with isoniazid. 1 In describing drug fever, it has been said that the temperature characteristically remains elevated, fixed at a relatively constant level. We report a case in which an intermittent spiking fever pattern led to diagnostic confusion, but was related to isoniazid ingestion. Report of a Case A 53-year-old man with pneumonia was transferred from another hospital. Two weeks previously a cough with sputum production had developed. One week before transfer, he had a shaking chill and became febrile and dyspneic. On his admission to the first hospital he had a temperature of 39 °C. A chest roentgenogram showed a left lower lobe infiltrate. Cephalexin monohydrate was administered; he became afebrile in three days and was then transferred to

Though drug fever from methyldopa is well known, to my knowledge fever and hypotension simulating septic shock have never been described in this country as a syndrome resulting from methyldopa therapy. Three such cases are presented here, all proved on rechallenge. They erroneously accounted for almost 6% of all cases of septic shock at St Elizabeth Medical Center in the last ten years. (Arch Intern Med139:196-197, 1979)

• Hydroxyurea has been rarely implicated as a cause of drug fever. In this report, we describe a patient who was highly febrile while receiving hydroxyurea for psoriasis. The fever disappeared after discontinuation of therapy with this drug; however, the fever recurred when the patient received hydroxyurea again. ( Arch Intern Med 141:260-261, 1981)

A prospective, double-blind evaluation of the efficacy and safety of prophylactic cephalosporins was done in 57 patients undergoing noncardiac thoracic surgery. Twenty-eight received cephalosporin therapy, and 29 received placebo. Overall, the incidence of postoperative infections was the same; infections developed in five (17.8%) of the 28 patients in the cephalosporin group and in five (17.2%) of the 29 patients in the placebo group. Of the five deaths attributable to infection, three occurred in patients receiving placebo and two in patients receiving cephalosporin therapy. No differences were noted in WBC counts, fever, duration of hospitalization, hypersensitivity reactions, or abnormal liver functions. However, drug fever, phlebitis, and abnormal renal function occurred more often in the patients receiving cephalosporin therapy. ( JAMA 241:1254-1256, 1979)

Another sulfonamide has been released for clinical use, and a list of toxic reactions are certain to follow. Little has been reported on the toxicity of sulfamerazine. Hageman, Harford, Sobin and Ahrens1guardedly endorse the drug. They report drug fever and a morbilliform eruption in 2, or 1.9 per cent, of their cases. Flippin, Gefter, Domm and Clark2found no dermatitis in 160 cases of pneumonia treated with sulfamerazine. Gefter, Rose, Domm and Flippin3reported 6 cases of drug eruption in 45 cases of meningococcic meningitis. Clark, Flippin and Murphy4had 3 per cent toxic dermatitis, none serious. Cutaneous reactions to the sulfonamides are frequent and are usually mild; however, severe and even fatal dermatitis has been reported.5 We are reporting a near fatal pemphigus-like reaction to sulfamerazine after the administration of only 4 Gm. over a period of forty-eight hours. REPORT OF CASE J.

During a study of a series of cases treated with sulfanilamide at the New Haven Hospital,1a characteristic febrile reaction, which will be described in this paper, was encountered in a fair proportion of the cases. The term drug fever will be used to denote this complication of sulfanilamide therapy. Long and Bliss2have mentioned the occurrence of fever following prolonged administration of sulfanilamide, as well as fever which appears promptly after large single doses of "Prontosil."3Massell4reported four cases of drug rash in a series of fourteen patients treated with sulfanilamide, but no data pertaining to time relationships and presence or absence of accompanying fever were included. In a series of 134 cases of various infectious conditions treated with sulfanilamide, the reaction to be described was encountered in twenty-one cases (summarized in the accompanying table), an incidence of 15.6 per cent. Characteristices that

Salicylazosulfapyridine (Azulfidine) is an azo compound of salicylic acid and sulfapyridine first introduced in 1942 by Svartz1for the treatment of ulcerative colitis. In the early clinical trials with this medicament hypersensitivity reactions, particularly drug fever and rash, were noted in about 5% of patients.2Five instances of leukopenia were observed but no cases of agranulocytosis or nephrolithiasis. Bargen,3Morrison,4and others5have also noted the usefulness of salicylazosulfapyridine and its low incidence of hematological complications. The first reported instance of agranulocytosis after the use of salicylazosulfapyridine was described by Levy in 1949.6His patient recovered from a complicating staphylococcic septicemia after treatment with penicillin. We are aware of only one other occurrence of agranulocytosis associated with administration of this drug.7In view of the extensive use of salicylazosulfapyridine in the treatment of patients with ulcerative colitis, the following case of agranulocytosis is

The increasing incidence of toxic reactions following thiouracil therapy is well known today. As a substitute for this drug Astwood and Vanderlaan 1 recommended propylthiouracil. There were no significant side effects encountered in their series of 100 cases. Reveno 2 in his observations on 54 patients found no evidence of toxic effect on the blood or blood-forming tissues. The only side effects encountered by the aforementioned authors were pruritus, urticaria and drug fever. Bartels 3 has given propylthiouracil to 450 patients at the Lahey Clinic with a toxicity incidence of 2 per cent. There has been 1 case of agranulocytosis, 5 cases exhibiting depressed leukocyte counts and 1 case revealing a typical fever response. In the reports received thus far, Hardy 4 knows of 1 case of agranulocytosis (Bartels') and states that a number of patients showed a drop in the leukocyte count, which soon rose despite the continuation of