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Case Reports
. 2025 Dec 5;15(4):e25.00230.
doi: 10.2106/JBJS.CC.25.00230. eCollection 2025 Oct 1.

Suspected Rifampicin-Induced Fever During Periprosthetic Joint Infection Treatment: A Report of 2 Cases

Sophie A Zwarts  1 , Kyrill Rykov  2 , Pelle Bos  1 , Joris J W Ploegmakers  3 , Wierd P Zijlstra  1 , Marjan Wouthuyzen-Bakker  4
Affiliations
Case Reports

Suspected Rifampicin-Induced Fever During Periprosthetic Joint Infection Treatment: A Report of 2 Cases

Sophie A Zwarts et al. JBJS Case Connect. .

Abstract

Case: Drug-induced fever is a rare adverse reaction to antibiotics. This case report describes 2 cases of suspected rifampicin-induced fever in patients undergoing periprosthetic joint infection treatment. Both patients experienced fever with the absence of inflammatory symptoms and a discrepancy between clinical improvement and persistent fever. Discontinuation of rifampicin led to rapid symptom resolution.

Conclusion: Drug-induced fever should be considered when fever persists without infectious symptoms and after excluding other causes. Prompt recognition and discontinuation can lead to rapid resolution and minimize unnecessary interventions.

Keywords: DAIR; PJI; S. aureus; THA; adult; adverse effects; antibiotic treatment; complication; elevated CRP; fever; infection; periprosthetic join infection; rifampicin; s. epidermidis; total hip arthroplasty.

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Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C757).

Figures

Fig. 1
Fig. 1
Development of fever and CRP in relation with rifampicin use, Case A. The graph depicts the timeline for Case A since primary admission (x-axis). The red line indicates body temperature (right y-axis), and the blue line represents CRP levels (left y-axis). Vertical lines denote key clinical time points as specified in the legend box at the top left corner. Fever developed 14 days after initiation of rifampicin and resolved within 2 days after discontinuation. CRP levels increased in parallel with the onset of fever and subsequently decreased following resolution.
Fig. 2
Fig. 2
Development of fever and CRP in relation with rifampicin use, Case B. The graph depicts the timeline for Case B since primary admission (x-axis). The red line indicates body temperature (right y-axis), and the blue line represents CRP levels (left y-axis). Vertical lines denote key clinical time points as specified in the legend box at the top left corner. Fever developed 4 days after initiation of rifampicin and resolved 3 days after discontinuation of rifampicin. CRP levels, since the start of rifampicin, rose in parallel with the onset of fever and decreased following its resolution.
See this image and copyright information in PMC

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