Correspondence

Pel-Ebstein Fever

N Engl J Med 1995; 333:66-67July 6, 1995

Article

To the Editor:

The Images in Clinical Medicine in the February 16 issue1 presents a temperature chart of cyclic fever in Hodgkin's disease, which the authors identify as Pel-Ebstein fever.

In his essay ``Making Sense,''2 Richard Asher refers specifically to Pel-Ebstein fever as a classic example of a condition that exists only because it has a name. As he points out, ``Every student and every doctor knows that cases of Hodgkin's disease may show a fever that is high for one week and low for the next week and so on. Does this phenomenon really exist at all? If you collect the charts of 50 cases of Hodgkin's disease and compare them with the charts of 50 cases of disseminated malignant fever, do you really believe you could pick out even one or two cases because of the characteristic fever?'' He then continues, ``out of curiosity I looked up the original papers, and Dr. Burrows kindly translated them for me.3,4 Both describe patients with chronic relapsing fever and splenomegaly but there is nothing in either paper to suggest any of them had Hodgkin's disease.''

The Journal has indeed proved Asher's argument that ``it does not matter whether or not Pel-Ebstein fever exists, my contention remains the same: the bestowal of a name upon a concept, whether real or imaginary, brings it into clinical existence.''

Andrew J.W. Hilson, F.R.C.P.
Royal Free Hospital and School of Medicine, London NW3 2QG, United Kingdom

4 References

1. 1

   Good GR, DiNubile MJ. Cyclic fever in Hodgkin's disease (Pel-Ebstein fever). N Engl J Med 1995;332:436-436
   Full Text | Web of Science | Medline

2. 2

   Asher R. Richard Asher talking sense. London: Pitman Medical, 1972:21-2.
   

3. 3

   Pel PK. Zur Symptomatologie der Sog: Pseudo-Leukamie. Berl Klin Wochenschr 1885;22:3-7
   

4. 4

   Ebstein W. Das chronische Ruckfallsfieber, eine neue Infectionskrankheit. Berl Klin Wochenschr 1887;24:565-568
   

Author/Editor Response

Dr. DiNubile replies:

To the Editor: Hilson questions the sensitivity, specificity of the cyclic pattern of fever known as Pel-Ebstein fever in Hodgkin's lymphoma. He contends that the disproportionate recognition of periodic fevers in patients with Hodgkin's disease occurs because this association has been specifically named ``Pel-Ebstein fever'' (even if the appellation is undeserved on the basis of the original reports). In his opinion, the association of cyclic fevers with Hodgkin's disease is no stronger than that of other causes of fever of unknown origin.

The predictive value of Pel-Ebstein fever obviously depends on the probability that a patient has lymphoma. In the setting of prolonged, unexplained fevers, in which the initial evaluation fails to disclose an infectious cause, my impression, shared by others,1 is that a classic pattern of Pel-Ebstein fever is characteristic of (although not pathognomonic for) Hodgkin's disease. However, there are few published data to substantiate this impression.2

The indisputable power of naming3 is even understood by young children,4 who wait nervously for Sebastian to give the princess a new name in order to save Fantasia from ``the Nothing'' in The Neverending Story. Developmental psychologists, linguists, and theologians have taught us how inextricably bound a concept and its name are5; it is not always clear, as Hilson insightfully points out, which comes first -- the name or the concept.

Mark J. DiNubile, M.D.
Cooper Hospital-Robert Wood Johnson Medical School, Camden, NJ 08103

5 References

1. 1

   Gelfand JA, Wolff SM. Fever of unknown origin. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 4th ed. Vol. 1. New York: Churchill Livingstone, 1995:544.
   

2. 2

   Colvett KL, Patel D, Smith JK. Multiple Beau's lines in a patient with fever of unknown origin. South Med J 1993;86:1424-1426
   CrossRef | Web of Science | Medline

3. 3

   Isaiah. 43:1.
   

4. 4

   Akiyama MM, Wilcox SA. Naming as a function of linguistic form-class and object categories. J Child Lang 1993;20:419-435
   CrossRef | Web of Science | Medline

5. 5

   John. 1:1.
   

Citing Articles (2)

Citing Articles

1. 1

   Ami Schattner, N. Keshet. (2010) Pel-Ebstein Cyclic Fever: Not Just Lymphoma. The American Journal of Medicine 123:7, e3
   CrossRef

2. 2

   Regis A. Vilchez, Chris J. Finch, Jeffrey L. Jorgensen, Janet S. Butel. (2003) The Clinical Epidemiology of Hodgkin Lymphoma in HIV-Infected Patients in the Highly Active Antiretroviral Therapy (HAART) Era. Medicine 82:2, 77-81
   CrossRef