Pel–Ebstein fever

Pel–Ebstein fever is a rarely seen condition noted in patients with Hodgkin's lymphoma in which the patient experiences fevers which cyclically increase then decrease over an average period of one or two weeks.[2] A cyclic fever may also be associated with other conditions, but it is not called "Pel–Ebstein fever" unless the fever is associated with Hodgkin's.[3]

Pel–Ebstein fever
Other namesEbstein–Cardarelli fever[1]
Symptomsfever, enlargement of lymph nodes, night sweats

Signs and symptoms

It is a special type of fever that cycles between a 3-10 day febrile period followed by the same length of afebrile period.

Causes

The cause is currently unknown although speculation centers on host immune response – particularly the cyclical release of cytokines, lymph node necrosis, and damaged stromal cells.[4]

Diagnosis

Cyclical fevers normally require periodic temperature monitoring to detect, though it is possible one could sense subjective changes in body temperature as well. To count as Pel-Ebstein fever diagnostic workup for Hodgkin's lymphoma would be required as well if that diagnosis was not already made.

Treatment

Treatment with non-steroidal anti-inflammatory agents or treatment of the underlying Hodgkin's (usually with chemotherapy) will help the symptoms.[2]

Eponym

The condition is named after Wilhelm Ebstein and P. K. Pel who both published papers in 1887 noting the phenomenon.[5][6][7] Both doctors published in the same journal, though Pel published first by several months. A long-term dispute persisted between Pel and Ebstein on the etiology of the condition.

Controversy

Researchers have speculated whether this condition truly exists, since some authorities anecdotally estimate only a 5–10% occurrence rate.[3] In his Lettsomian Lecture Making Sense, delivered to the Medical Society of London in 1959, Richard Asher refers to Pel–Ebstein fever as an example of a condition that exists only because it has a name. "Every student and every doctor knows that cases of Hodgkin's disease may show a fever that is high for one week and low for the next week and so on. Does this phenomenon really exist at all?..."[8]

References
  1. G. Fradà – Semeiotica Medica nell' adulto e nell'anziano. Piccin p.48
  2. Mauch, Peter; James Armitage; Volker Diehl; Richard Hoppe; Laurence Weiss (1999). Hodgkin's Disease. Lippincott Williams & Wilkins. pp. 327–328. ISBN 978-0-7817-1502-7.
  3. Hochberg, Ephraim P. "eMedicine – Pel–Ebstein Fever". Retrieved 2007-07-08.
  4. Ree, HJ (1987). "Stromal macrophage-histiocytes in Hodgkin's disease. Their relation to fever". Cancer. 60 (1479): 1479–84. doi:10.1002/1097-0142(19871001)60:7<1479::AID-CNCR2820600713>3.0.CO;2-G. PMID 3621125.
  5. Ebstein, Wilhelm (1887). "Das chronische Ruckfallsfieber, eine neue Infectionskrankheit". Berlin Klin Wochenschr. 24 (565).
  6. Pel, P. K. (1887). "Pseudoleukaemie oder chronisches Ruckfallsfieber?". Berlin Klin Wochenschr. 24 (565).
  7. synd/438 at Who Named It?
  8. Hilson, A.J.W.; DiNubile, M.J. (1995-07-06). "Correspondence". New England Journal of Medicine. 333 (1): 66–67. doi:10.1056/NEJM199507063330118. PMID 7777006.. They cite Richard Asher's lecture Making Sense (Lancet, 1959, 2, 359)
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