The immunocompromised patient is at risk for developing a wide variety of life-threatening infectious disease. Predicated on the underlying immune system defect, many diverse microbes, including those handled routinely by the immunocompetent host, can become pathogens. Fever is often the sole finding, and the incidence of serious disease in this group of patients is high. Data on emergency department (ED) utilization rates by immunocompromised patients are not well documented. One study found that 5% of ED patients had a cancer history. Of those, 43% had an oncology-related visit and, of those with an oncology-related visit, 17% presented with fever.<sup>53 Swenson K., Rose M.A. , et al. Recognition and evaluation of oncology-related symptoms in the Emergency Department Ann Emerg Med 1995 ;  26 : 12-17  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Another study of heart and lung transplant patients identified fever as the most common reason for an ED visit (37%).<sup>52 Sternbach G.L., Varon J. , et al. Emergency department presentation and care of heart and heart/lung transplant recipients Ann Emerg Med 1992 ;  21 : 1140-1143  [cross-ref]

Cliquez ici pour aller à la section Références</sup> HIV disease and increasing success in transplant medicine, cancer therapy, and rheumatologic therapy have contributed to the increased prevalence of immunocompromise in the general population.

Emergency medicine physicians should develop a systematic approach for patients with compromised immune systems who present with fever, including historical and physical findings pertinent to these patients, with attention to details that are atypical or specific to the immunocompromised state; a diagnostic work-up applicable to most patients with immune system dysfunction; a knowledge of common clinical scenarios of immunosuppression, focusing on unique presentations; and treatment strategies, including disposition options.