Protocolo diagnóstico y tratamiento del cuadro febril en el paciente con enfermedad inflamatoria intestinal

Abstract

Fever is a common clinical manifestation of inflammatory bowel disease (IBD). Nevertheless, fever should not be systematically attributed to inflammation. There are multiple diseases that progress with fever and they may be masked by a flare-up of bowel inflammation. Therefore, a differential diagnosis is recommended. One of the main causes of febrile syndrome is infections. Patients with IBD are at increased risk for infections, in part because of immunosuppressive treatment. In addition, they are more susceptible to certain microorganisms, including enteropathogens such as Clostridioides difficile, and mycobacteria in patients receiving tumor necrosis factor alpha-inhibiting drugs. Second, neoplastic processes, both solid and hematological, can progress with fever, with the disease itself and the use of thiopurines being the main associated risk factors. Other causes of fever that should be considered are inflammatory or autoimmune disorders and drug fever. This protocol proposes an algorithm for the differential diagnosis of febrile illness in patients with IBD.