Reimann's "Habitual Hyperthermia" Responding to Hormone Therapy

Abstract

A 25-year-old woman presented with fever of unknown origin, exhibiting malaise and low-grade fevers in evenings. These fevers exhibited a pattern of starting mid-menstrual cycle with resolution around the onset of menses, matching a pattern of "habitual hyperthermia" reported by H. Reimann in the 1930s. Extensive workup was unremarkable, and the fevers improved on oral synthetic estrogen and progesterone therapy.

Keywords: fever unknown origin; habitual hyperthermia.

Figure 1.

Pattern of fevers. (A) Ten days of representative body temperatures measured orally at approximately 8:00 am, noon, and 8:00 pm are plotted, showing changing amounts of diurnal variation over time. (B) The 8:00 pm temperatures over 300 days are plotted against trials of prednisone and colchicine, as well as onset of menstrual cycles. (C) The median temperatures across 10 menstrual cycles are plotted in relationship to start of menses. (D) The 8:00 am and 8:00 pm temperatures in the 3 months preceding treatment with oral levonorgestrel/ethinyl estradiol are plotted. (E) Temperatures in the 3 months after starting oral levonorgestrel/ethinyl estradiol are plotted. The shaded area indicates the timing of acute otitis media and mastoiditis culminating in mastoidectomy and tympanostomy tube placement. (F) Temperatures are plotted after several months receiving oral levonorgestrel/ethinyl estradiol.