Role of Nonsteroidal Antiinflammatory Drugs in the Differential Diagnosis of Neoplastic Fevers versus Fevers of Infectious Etiology

Abstract

Objective:

To determine the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the differential diagnosis of neoplastic fevers versus fevers of infectious etiology and to recommend a therapeutic regimen as well as a suggested treatment duration of NSAID therapy to aid in this diagnosis.

Data Sources:

The English-language literature was searched using MEDLINE, Index Medicus, and bibliographic reviews of relevant textbooks and review articles.

Conclusions:

NSAIDs have induced dramatic antipyretic effects when administered to patients with cancer whose fevers are particularly disabling and often a major contributor to patient morbidity and mortality. When a fever persists after infection has been ruled out, an NSAID test may be of diagnostic value for a neoplastic fever. Naproxen, indomethacin, and diclofenac all have been studied and demonstrated efficacy. A reduction or cessation of a neoplastic fever can be expected within 24 hours after initiation of NSAID therapy. However, NSAID therapy should be continued for three days before cessation of therapy or a change to another NSAID is considered.