Pyrotherapy is “the use of fever to treat disease.”1 This ancient modality can be traced as far back as Hippocrates, who noted the beneficial effects of malaria on epilepsy. Subsequently, Galen noticed that fever had a beneficial effect on psychiatric illness. Other early physicians to make this connection were Pinel (1745-1826), Esquirol (1772-1840), Briquet (1796-1881), and Maudsley (1835-1918).1
It was Julius Wagner-Jauregg whose Nobel Prize winning work brought pyrotherapy to the mainstream. He noted the effects of malaria on treatment of general paralysis of the insane (GPI), now referred to as neurosyphilis 2 He inoculated patients with GPI with blood containing malaria and allowed them to experience several episodes of fever before treating them with quinine to cure the malaria. Because the initial experiments yielded promising results, malaria therapy was adopted as treatment of choice for GPI and other forms of psychosis.1 Wagner-Jauregg’s clinic used this approach in treating over 1000 patients with GPI, with approximately 60% experiencing varying degrees of remission. Globally, approximately 80% of treated patients were reported to achieve full remission, with another 20% achieving partial remission.1 However, after the discovery of penicillin for the treatment of syphilis and the advent of convulsion-oriented treatments for psychotic disorders, pyrotherapy fell out of favor.1
A recent case report by Zachary Suchlag, DO, and colleagues describes the role of fever in improving symptoms of a 43-year-old African American woman with schizoaffective disorder (bipolar type), severe psychosis, and a medical history of iron deficiency anemia and asthma.1
The patient was admitted to a psychiatric unit after experiencing suicidal ideation and worsening psychosis, including paranoia, agitation, disorganization, and threatening behavior. The medication regimen she had been receiving prior to admission consisted of haloperidol decanoate, quetiapine, divalproex sodium, clonazepam, and benztropine.
During her hospitalization, the patient experienced significant psychotic symptoms, despite adjustments to her medication regimen. She began treatment with lorazepam and diphenhydramine orally and intramuscularly with chlorpromazine. Clozapine was initiated and the patient showed some improvement. However, while still hospitalized for residual psychotic symptoms, she became febrile and tachycardic, and complained of poor appetite, sore throat, and headache.
Her blood culture was positive for a-hemolytic streptococci, although her rapid test for streptococcal infection was negative. Nevertheless, treatment with antibiotics was initiated. Despite the treatment, she remained intermittently febrile (102.74°F/39.3°C), and her tachycardia worsened. She was transferred to the medical unit of the general hospital and her antibiotics were broadened. Due to her complicated presentation, she discontinued haloperidol and benztropine. Her full medical workup is summarized in Table 1.