Pel-Ebstein Fever

This eponym has been raised several times in the month of July in regards to patients presenting with either fever of unknown origin or fever in the context of a previous malignancy. Pel-Ebstein fever refers to a cyclical fever in the context of Hodgkins lymphoma (HL). The description is of fevers lasting days to weeks with defervescence of similar duration. The duration of the absence of fever may decrease as disease progresses. Pal and Ebstein described this separately in two publication in the mid 1880's. Editorials have been published commenting on the original articles, which recognize that the prevalence of HL was not confirmed in many of the subjects described in the original article. It has also become more recognized that other causes of fever can produce a similar pattern, where case reports of CMV and tuberculosis report cyclical fevers (Schattner 2010.). The diagram posted is from a NEJM clinical image from 1995 which charts the fevers of a patient with HL, demonstrating the classic pattern. How often patient with HL present with this pattern is unclear, but its thought to be rare. If nothing else, the eponym has labelled this phenomenon allowing it to be remembered, which may be the only reason its discussed. There are other systemic manifestations of lymphoma that are just as interesting, but don't seem to have the same notoriety.

Alcohol induced pain, usually at the site of involved lymph nodes or bony disease was first described in the mid 20th century. Its reported to occur quickly after the ingestion of alcohol in  less than 10% of patients. Pruritis is a common manifestation of lymphoma, where ~10-15% will experience this, sometimes being quite severe. It may be an early presenting symptom and when severe may carry some prognostic value. I would argue that pruritis is less commonly mentioned as a symptom of HL than pruritis, and may be a more valuable piece of knowledge.