Malignant
Fever
PATHOPHYSIOLOGY & MANIFESTATIONS
OF FEVERS DUE TO HEMATOLOGIC & LYMPH NODE
MALIGNANCIES
Fasmina Sherin
Roll no 34
Malignant Fever – Definition
Malignant fever refers to fever caused directly or indirectly by
cancer (malignancy), not due to infection. It is typically due to
tumor-induced inflammation, cytokine release, or paraneoplastic
syndromes.
Aetiology of Malignant Fever
•Hematologic Malignancies: •Paraneoplastic Syndromes:
•Acute leukemias (AML, ALL) • Cytokine release (e.g., IL-6, TNF-α)
•Lymphomas (Hodgkin and Non-Hodgkin) • Immune system activation
•Multiple myeloma
•Tumor Necrosis or Obstruction:
•Solid Tumors: • Necrosis of rapidly growing tumors
•Renal cell carcinoma
• Obstruction of ducts or vessels causing
•Hepatocellular carcinoma
•Lung cancer inflammation
•Pancreatic cancer
•Colorectal cancer •Treatment-related (but not infectious):
•Osteosarcoma • Chemotherapy-induced tumor lysis
• Radiation-induced inflammation
•Metastatic Cancers:
•Especially with liver or bone metastasis
Aetiology of Malignant Fever
Pathophysiology
Malignancy-associated fevers are largely due to inflammatory cytokine release
and tumor-related immune dysregulation, not direct infection
1. Cytokine Production
•Tumour cells and immune cells (e.g., macrophages, T-cells) within the tumor
microenvironment release endogenous pyrogens:
• IL-1, IL-6, TNF-α, and interferon-γ
•These cytokines act on the hypothalamus to raise the thermoregulatory set
point, resulting in fever.
Pathophysiology
2. Tumour Necrosis and Infiltration
•Rapidly growing tumours may outgrow their blood supply, leading to necrosis,
which triggers inflammation.
•Bone marrow infiltration (especially in leukaemias/lymphomas) disrupts normal
haematopoiesis and activates systemic immune responses.
Pathophysiology
3. Paraneoplastic Syndromes
•Some tumors (especially Hodgkin lymphoma) trigger immune reactions or
produce cytokines/hormones that can indirectly cause fever.
4. Immunosuppression and Infection
•Some cancers and their treatments (chemotherapy, steroids) suppress
immunity, making patients prone to infections that can also present with fever.
MANIFESTATIONS
These vary depending on the specific malignancy, but fever is often intermittent or persistent
and is usually not responsive to antibiotics unless there is a concurrent infection.
Hematologic malignancies
Lukemia (Acute)
Multiple Myeloma
Lymph Node malignancies
Hodgkins Lymphoma
Non-Hodgkins Lymphoma
MANIFESTATIONS
•Hematologic Malignancies
[Link] (especially acute)
• Fever is often the first symptom.
• Accompanied by:
• Fatigue, weight loss
• Pallor, bleeding tendencies (due to thrombocytopenia)
• Infections (due to neutropenia)
• Bone pain due to marrow expansion
[Link] Myeloma
• Fever is less common, but may occur with secondary infections
• Bone pain, anemia, renal dysfunction, hypercalcemia
MANIFESTATIONS
Lymphomas
[Link] Lymphoma
Pel–Ebstein fever: cyclic high fevers (especially in Hodgkin)
•High fever for 3–10 days
•Followed by an afebrile (no fever) period of similar duration
•This cycle repeats over weeks
• Other features:
• Painless lymphadenopathy
• Night sweats
• Weight loss Splenomegaly, hepatomegaly
MANIFESTATIONS
2. Non-Hodgkin Lymphoma
• Fevers can be high-grade and prolonged
• May also present with rapidly enlarging lymph nodes
Key Diagnostic Clues
•Persistent fever with no clear infectious cause
•Presence of B symptoms: fever, night sweats, weight loss
•Abnormal blood counts (anemia, leukocytosis/leukopenia,
thrombocytopenia)
•Elevated LDH, ESR, and CRP
•Imaging showing lymphadenopathy, hepatosplenomegaly
•Biopsy for definitive diagnosis
•B symptoms are systemic constitutional symptoms that are significant in the staging and
prognosis of lymphomas, especially Hodgkin lymphoma and aggressive non-Hodgkin
lymphomas
Summary
Malignancy Fever Mechanism Other Features
Cytokine release, marrow Fatigue, pallor, infections,
Leukemia infiltration bleeding
B symptoms, painless nodes,
Hodgkin Lymphoma Pel–Ebstein fever, cytokines splenomegaly
Rapid node growth, systemic
Non-Hodgkin Lymphoma Cytokines, tumor burden signs
Infections, bone marrow Bone pain, renal issues,
Multiple Myeloma suppression anemia
Thank You!
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