Management of Fever in Patients on Rinvoq (Upadacitinib)

Diagnostic Approach

The American College of Physicians recommends obtaining multiple sets of blood cultures before starting antibiotic therapy, with a sensitivity of 40-80% in the first week of symptoms, and performing a complete blood count with differential to identify neutropenia, thrombocytopenia, or atypical lymphocytes 1
The Infectious Diseases Society of America suggests conducting a comprehensive metabolic panel to assess hyponatremia, hypoalbuminemia, and elevated liver enzymes, and obtaining a urine analysis and urine culture (catheterized sample) 1
The American Thoracic Society recommends performing a chest radiograph to evaluate for pneumonia, tuberculosis, or mediastinal lymphadenopathy 1

The Infectious Diseases Society of America recommends starting empirical antibiotics immediately, without waiting for culture results, if the patient is clinically unstable or deteriorating, with ceftriaxone intravenously as the first-line agent, continued for 14 days to reduce the risk of recurrence 1
The Society for Healthcare Epidemiology of America suggests broadening coverage to include resistant gram-positive organisms, anaerobes, and antifungal therapy when deep infection or sepsis is suspected 2, 1

The Infectious Diseases Society of America recommends carefully monitoring patients for response, adverse effects, emergence of secondary infections, and development of drug-resistant organisms, with a median time to defervescence of 5 days in patients with hematological malignancies and 2 days in low-risk patients 2

The National Comprehensive Cancer Network recommends using acetaminophen (paracetamol) as needed to control fever, and ensuring adequate hydration with intravenous fluids, with Ringer's solution used to maintain hydration in fever, but with primary focus on identifying and treating the underlying cause 5, 3

The American College of Physicians advises against relying on the response to antipyretics to differentiate between bacterial and viral infection, and against adding vancomycin empirically without specific indications, as it promotes resistance 1
The Infectious Diseases Society of America recommends that patients who have experienced anaphylaxis or toxic epidermal necrolysis never receive the offending drug again 3