Fever is a common problem encountered by physicians daily. Among the etiologies, drug fever is relatively difficult to be diagnosed. Un-recognition of drug fever will expand medical expenditure massively by extra testing, empiric therapy, and longer hospital stays. This case report describes a cirrhotic patient of hepatocellular carcinoma who developed a drug fever 2 days after introducing ciprofloxacin to control bacterial infection complicated with transcatheter arterial chemoembolization (TACE).  The  fever  was  associated  with  relative  bradycardia  without  eosinophilia. Infections and sequelae of TACE were excluded. A Naranjo score of 6 points favored the probability of drug fever related to ciprofloxacin. Our experience could remind physicians that drug fever should be suspected in febrile patients with relative bradycardia after excluding other possibilities and ciprofloxacin could be one of the etiologies.

本篇個案報告的目的是描述Ciprofloxacin引起的藥物熱。由於幾乎每一種藥物都可能會引起藥物熱，因此診斷藥物熱相當困難，而未診斷的藥物熱，會產生多餘的檢查、治療及增加住院天數，從而造成健保總額預算下醫院的財務負擔，因此早期正確的診斷藥物熱，可以增進醫療品質並改善醫院財務負擔。個案病人是住院接受經導管肝動脈化學栓塞(transcatheter arterial chemoembolization；TACE)處理1.5公分肝癌的患者。病人在TACE後第二天開始發燒合併寒顫持續5天，因伴存高CRP和白血球增多，懷疑感染症而給予Ciprofloxacin治療。治療開始後病情有顯著進步且發燒已改善﹔但隨後再出現尖峰性發燒(spiking fever)合併相對性心搏過慢(Relative bradycardia)，病人臨床表現仍相當輕鬆，經過詳細的理學及實驗室檢查，沒有發現其他發燒病因，也未出現嗜伊紅性白血球增多症(Eosinophilia)，在高度懷疑Ciprofloxacin引起的藥物熱而停藥後，發燒於次日漸漸自行消退。以Naranjo藥物不良反應評分表評估為6分，顯示Ciprofloxacin很可能(probable)可以引起藥物熱。由於Ciprofloxacin未曾被報導會引起藥物熱。我們的經驗可提供臨床醫師往後處理疑似Ciprofloxacin引起藥物熱之參考。