Page 113 - JCBP-3-3

Journal of Clinical and
Basic Psychosomatics Psychogenic fever and palpitations in autonomic dysfunction

Mental health disorders can also provoke functional Upon examination, the patient had a blood pressure
somatic symptoms, which are often not promptly of 149/98 mmHg and a heart rate of 98 beats/min.
distinguished from physical illnesses and are not Cardiopulmonary auscultation revealed no abnormalities,
alleviated by regular treatments. Psychogenic fever (PF), and the remainder of the physical examination was also
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a psychosomatic disorder characterized by elevated body unremarkable. His body mass index (weight in kg divided
temperature typically triggered by emotional distress, was by the square of the height in m) was 27.1, and his waist
first described in the 1950s. This “emotion-evoked fever” circumference measured 89 cm. He appeared comfortable
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phenomenon has been documented in animals, including during the examination.
rats and rabbits, in response to mating or exposure to The patient had a history of ventricular septal
noxious stimuli. In humans with PF, core body temperature defect (VSD) closure 1 year prior, after which he began
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can rise during episodes of acute or chronic stress, ranging experiencing the above symptoms. The recurrent low-grade
from mild (37 – 38℃) to severe (up to 41℃) elevations. fever typically occurred in the afternoon, with temperature
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Despite being a primary cause of fever of unknown origin fluctuations between 37.1 and 37.5℃, resolved by bedtime.
(FUO), many patients with PF are discharged without a
definitive diagnosis. PF is often accompanied by a range However, his body temperature could rise to 37.8℃
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of somatic symptoms, such as dizziness, chronic fatigue, under emotional agitation. The patient also reported poor
cardiac manifestations, gastrointestinal disturbances, and sleep quality, frequently waking up during the night. His
genitourinary complaints, which overlap with those of other medical history included hyperlipidemia (characterized by
physical conditions, complicating the diagnostic process elevated triglycerides), fatty liver, and gallstones. He was
not currently on any medications, did not use tobacco, and
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and posing a significant challenge. As a psychosomatic did not consume alcohol. His family history was unknown.
condition, PF can be effectively treated with anxiolytic
and sedative psychotropic medications, or by addressing All clinical information was gathered during his first visit to
underlying stressors through natural interventions or the clinic on February 19, 2024. Given that the examination
psychotherapy, rather than with antipyretics. However, was incomplete, no treatment was initiated at this time.
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the diagnostic complexity often leads to inappropriate Considering the recurrent fever, relevant laboratory
treatments, exacerbating the physical distress experienced tests were conducted, showing a normal erythrocyte
by affected individuals. sedimentation rate and C-reactive protein levels

This case report describes a case of recurrent low- (February 22, 2024). Routine blood tests, urinalysis, and
grade FUO accompanied by persistent cardiac symptoms, urine sediment test (all February 22, 2024) revealed no
highlighting the absence of a definitive etiology for the abnormalities. Viral serology (October 12, 2023, and
fever. It underscores the importance of cardiologists February 22, 2024) ruled out a recent viral infection.
acquiring a foundational understanding of mental health Blood cultures (October 10, 2023, and February 22, 2024)
to facilitate the diagnosis of psychosomatic disorders, and autoimmune screening (February 22, 2024) were
which may present with fever as the primary symptom. also negative. Thyroid function tests (February 22, 2024)
The report delineates the diagnostic challenges associated indicated normal thyroid hormone levels. Considering
with psychosomatic disorders and outlines the steps the palpitations, myocardial injury markers (creatine
and interventions taken to address and mitigate these kinase, creatine kinase-MB, myoglobin, cardiac troponin,
complications. In addition, based on clinical experience and lactate dehydrogenase) were tested and found to be
and an extensive review of the literature, we propose a within normal limits (February 22, 2024). Transthoracic
diagnostic algorithm for outpatients suspected of having echocardiography (February 22, 2024) and cardiovascular
underlying mental disorders, aiming to guide clinical magnetic resonance imaging (March 1, 2024) revealed no
practice and improve patient outcomes. abnormalities. No significant findings were noted in the
bilateral carotid arteries.
2. Case presentation The patient completed a set of questionnaire assessments

A 58-year-old man attended the Rare Disease Clinic (an (February 21, 2024), evaluating various aspects of his
outpatient department for multidisciplinary diagnosis health:
and treatment) at our hospital in Beijing, China, with a (i) Personal Information Questionnaire: This
1-year history of recurrent low-grade fever (37.1 – 37.5℃) questionnaire collected demographic data, lifestyle
and intermittent palpitations (medical ID: 44820704). He habits (such as smoking and alcohol consumption),
also experienced wheezing and weakness during physical physical activity levels, fatigue, pain presence, motor
exertion, such as walking or climbing three consecutive coordination, upper limb grip strength, and balance
flights of stairs. (measured by one-legged stance duration).

Volume 3 Issue 3 (2025) 107 doi: 10.36922/jcbp.4864