Metastatic Lung Cancer With Morphine-Induced Fever During Palliative Radiation

What happened, in summary

A 58-year-old woman developed cough and chest pain in March 2021. Evaluation found lung cancer with metastases to the brain and bone, establishing Stage IV disease. She initially received pemetrexed and carboplatin chemotherapy with bevacizumab. After genetic testing, treatment was changed to dacomitinib in April 2021, which she continued taking.

In April 2022, she was admitted for pain in the lower back and sacral area with mild numbness in the left leg. Lumbar radiation was started for the painful metastatic disease and reduced her pain. During treatment, she developed radiation-related bowel symptoms and episodes of breakthrough pain.

Morphine was given when other pain medicines were not enough. Each time she received morphine, her pain improved but she developed fever, reaching 39.2°C after a repeat dose. Infection testing did not identify another cause, and the fever resolved after morphine was stopped. Her pain regimen was changed, and the fever did not recur.

She remained on dacomitinib during this period. At discharge, her general condition was satisfactory and her pain had improved, while care for her metastatic lung cancer was ongoing.