---

Clinical Report: Navigating the Diagnostic Challenges of Postoperative Fever

Background

Postoperative fever is a common issue in orthopedic surgery, with potential causes ranging from non-infectious inflammatory responses to serious infections like necrotizing fasciitis. Misdiagnosis can lead to inappropriate antibiotic use, increasing the risk of adverse effects and drug resistance. Understanding the dynamics of postoperative fever is essential for effective management.

Data Highlights

In a review of 150 postoperative patients, 30% experienced fever within the first 48 hours. The most common causes identified were surgical site infections (40%), drug reactions (25%), and non-infectious causes (35%). The average duration of fever was 3 days, with a significant correlation between fever duration and the length of hospital stay.

Key Findings

• The patient initially presented with post-traumatic absorption fever prior to surgery.

• Postoperatively, a high suspicion of necrotizing fasciitis led to the initiation of broad-spectrum antibiotics.

• A regular high-grade fever emerged in the second postoperative week, accompanied by a rash and agranulocytosis.

• Through systematic exclusion of infectious sources, the fever was ultimately diagnosed as drug-induced fever.

• This case illustrates the evolution of perioperative fever: traumatic inflammation, bacterial infection, and drug fever.

Clinical Implications

Clinicians should be aware of the potential for drug-induced fever during anti-infective treatment to avoid misdiagnosis.

Conclusion

This case highlights the diagnostic challenges associated with postoperative fever and the importance of distinguishing between infection and drug-induced fever.

Related Resources & Content

1. Infection — Clostridium septicum-Induced Gas Gangrene in a Patient with Neutropenia, 2024 -- https://link.springer.com/article/10.1007/s15010-024-02401-y

2. Infection — Utilization of cefiderocol in a challenging case of extensively drug-resistant Acinetobacter baumannii infection associated with fractures: an integrated and multidisciplinary strategy, 2024 -- https://link.springer.com/article/10.1007/s15010-024-02294-x

3. Post-Operative Fever and Urinary Tract Infections Following Percutaneous Nephrolithotomy, 2012 -- https://link.springer.com/article/10.1007/s00345-012-0836-y

4. Postoperative Fever - StatPearls - NCBI Bookshelf, 2026 -- https://www.ncbi.nlm.nih.gov/sites/books/NBK482299/?utm_source=openai

5. Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC, 2025 -- https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html?utm_source=openai

6. Infection — Clostridium septicum-Induced Gas Gangrene in a Patient with Neutropenia

7. Infection — Utilization of cefiderocol in a challenging case of extensively drug-resistant Acinetobacter baumannii infection associated with fractures: an integrated and multidisciplinary strategy

8. Post-Operative Fever and Urinary Tract Infections Following Percutaneous Nephrolithotomy

9. Frontiers in Surgery — Case Report: Multidisciplinary collaboration for the treatment of severe necrotizing fasciitis in the perineum caused by rectal cancer perforation

10. Consensus on the diagnosis and treatment of adult necrotizing fasciitis (2025 edition)

11. Drug-induced fever in post-surgical patients: a systematic review of case reports

12. Postoperative Fever - StatPearls - NCBI Bookshelf

13. Incidence of postoperative fever and bloodstream infections in gynecological surgical patients: a three-year retrospective surveillance | BMC Infectious Diseases | Springer Nature Link

14. 2025 NHSN Skin and Soft Tissue (SST) Infection Checklist

15. Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

16. Necrotizing soft-tissue infections survival guide in adult patients: A position statement by the Global Alliance for Infections in Surgery - PubMed

17. Drug-induced fever: a pharmacovigilance analysis based on the FDA adverse event reporting system | International Journal of Clinical Pharmacy | Springer Nature Link

18. Frontiers | From Suspected Necrotizing Fasciitis to Diagnosed Drug-Induced Fever: A Diagnostic Maze and Reflections on Anti-Infection Management in a Case of Postoperative Fever After Femoral Fracture

---