The Fever of Laennec's Cirrhosis †

Fever is not regarded by most physicians as a prominent or common clinical manifestation of uncomplicated Laennec's cirrhosis. When present, it is generally attributed to intercurrent infection, gastrointestinal hemorrhage or, less commonly, to complicating hepatoma. However, there is reason to believe that the cirrhotic process itself may give rise to fever. Although earlier observers had commented on the fever seen occasionally in alcoholic patients with cirrhosis,"' Carrington8 first documented its frequency (41 per cent) in uncomplicated cases. Almost a quarter of Eppin-ger's cases had fever apparently related to cirrhosis itself.10 Other re-ports1' '-' " ' have mentioned fever as a clinical sign of cirrhosis, but few of these have included sufficient clinical, bacteriological, and pathological details to permit accurate conclusions about the significance of pyrexia in this disease. In studying a large group of alcoholic patients with Laennec's cirrhosis, we have been impressed by the frequent occurrence of fever, often prolonged in duration and striking in degree. In some patients, the pyrexia has been clearly related to associated infection or neoplasm, but in many no cause other than the liver disease itself has been demonstrated. Often the fever has been a matter of great concern and has led to fruitless diagnostic procedures and to ineffective therapeutic trials of antibiotics. We have reviewed our experience with patients having proven Laennec's cirrhosis in order to determine the incidence, characteristics, and significance of fever in this disease.