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April 18, 1977

Extreme Pyrexia

JAMA. 1977;237(16):1691-1692. doi:10.1001/jama.1977.03270430033007

To the Editor.—  Dr Simon's article entitled "Extreme Pyrexia" (236:2419, 1976) was very informative, but certain aspects require clarification as well as amplification, so that the clinician has a clear view of the entire problem.Although infection is the most common cause of fever, it is a rare cause of sustained hyperpyrexia. As brought out in the article, other conditions that are suggested by the patient's history and circumstances (eg, heat stroke, tumor, hyperthyroidism, and malignant hyperpyrexic response to anesthetia) must also be considered. However, the discussion overlooked an important medical condition, pheochromocytoma, which must be seriously considered and assiduously ruled out.Despite a widespread knowledge of this disease, pheochromocytoma has principally been an autopsy diagnosis, usually found after an unexpected cardiovascular or cerebrovascular catastrophe. In an extensive review of the literature, Weintraub and co-workers1 stressed the importance of extreme pyrexia in association with sweating and pulsatile headaches as