Non-small cell lung cancer presenting with neoplastic fever at diagnosis and relapse.

Fever occurs frequently in cancer patients, and neoplastic fever is a well-described paraneoplastic phenomenon in patients with lymphoma, acute leukemias, and renal cell carcinoma. It is also more commonly encountered in metastatic disease. Treatment options include disease-specific therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and steroids. Lung cancer is one of the most common cancers, yet fever as a manifestation of this malignancy has not been emphasized. In this report, we describe an unusual case of non-metastatic non-small cell lung cancer (NSCLC) presenting with neoplastic fever at both diagnosis and relapse, responding on each occasion to disease-specific treatment, and provide a review of the management of neoplastic fever.

Patient and disease characteristics, and outcome of treatment defaulters from the Singapore TB control unit--a one-year retrospective survey.

SETTING: The Singapore Tuberculosis Control Unit. OBJECTIVES: 1) To identify any demographic, social, disease or treatment-related characteristics which may be predictive of patients defaulting from treatment; 2) to assess the effectiveness of home visits as a means of defaulter recall; 3) to ascertain outcome in these patients. DESIGN: A retrospective, case-controlled study of TB treatment defaulters, defined as patients who missed their scheduled appointments and required a home visit to recall for treatment. Controls were randomly selected, non-defaulting patients who started treatment on the same dates as the defaulters. RESULTS: Forty-four patients required home visits in 1996. Compared to controls, defaulters were more likely to be non-Chinese, and to live on their own or with friends. There was no significant association of defaulting with age, sex, marital or employment status, disease characteristics, or treatment-related factors. Seventy per cent defaulted during the continuation phase of treatment. Home visits did not result in contact with the patient (or any other person) 41% of the time. Although 48% of the defaulters remained lost to follow-up at the time of the survey, all but one of the sputum-positive patients had bacteriologically converted by the time of default. CONCLUSION: Non-Chinese ethnicity and lack of family support were found to be factors strongly predictive of default. Age, sex, marital and employment status, treatment-related factors and disease characteristics were not significant in distinguishing those at risk for defaulting.