Mesothelioma and Fever: How Common Is It and What Does It Mean?

Fever can occur in mesothelioma, but it is not the most prominent symptom compared with chest pain, shortness of breath, cough, and weight loss. Still, many clinical summaries list fever and night sweats among recognized systemic (whole‑body) signs, especially in pleural mesothelioma. ^{[1] [2]} Fever during or after treatment also warrants prompt medical assessment because it may signal infection or treatment‑related complications. ^{[3] [4]}

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How Often Does Fever Occur?

• Pleural mesothelioma commonly presents with chest pain, dyspnea (shortness of breath), cough, fatigue, weight loss, and can include fever and sweating/night sweats as part of the symptom spectrum. ^{[1] [2]}
• Case series and registry analyses have documented fever at presentation in a subset of patients. For example, historical cohorts reported fever as an initial symptom in about a tenth of pleural cases, highlighting that while not universal, fever is a recognized presentation. ^[5]

In short, fever is possible and clinically relevant, but not as frequent as respiratory symptoms; its presence should be interpreted in clinical context. ^[2]

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What Does Fever Typically Indicate?

1) Tumor‑Related Inflammation (Paraneoplastic)

Mesothelioma is strongly linked to chronic inflammation triggered by asbestos exposure. Systemic inflammation markers, such as elevated C‑reactive protein (CRP) and neutrophil‑to‑lymphocyte ratio (NLR), correlate with symptom burden and survival. ^{[6] [7]} Laboratory and animal model data suggest tumor production of inflammatory cytokines (notably interleukin‑6, IL‑6) can drive fever, weight loss, and thrombocytosis as paraneoplastic features. ^[8] These cytokine‑mediated effects may precede visible tumor growth and contribute to systemic symptoms. ^[8]

Clinically, higher baseline CRP (≥1 mg/dL) has been associated with shorter overall survival and appears to influence which treatment strategies confer benefit, supporting the idea that fever can reflect a heightened inflammatory state and more aggressive disease biology. ^[9] Elevated NLR and related indices similarly predict poorer outcomes. ^{[10] [6]}

2) Infection (Especially During Chemotherapy)

For those receiving mesothelioma therapies (e.g., platinum plus pemetrexed, with or without bevacizumab), fever can signal infection or neutropenic sepsis, a medical emergency. Guidance advises urgent contact with the care team or emergency evaluation for temperature ≥38°C, chills/shivers/sweats, sore throat or cough, rapid heartbeat, or feeling unwell. ^{[3] [11] [12]} During treatment, lung complications and infections are uncommon but can be serious, and fever is one of the warning signs. ^{[13] [4]}

3) Fluid Collections and Disease Progression

Recurring pleural effusion (fluid around the lung) and abdominal involvement in peritoneal mesothelioma can be associated with systemic symptoms like fever, night sweats, anorexia, and fatigue due to ongoing inflammation. ^{[14] [7]} In peritoneal mesothelioma, fever has been reported among presenting symptoms in multicenter series. ^[15]

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Clinical Implications and Next Steps

• Assessment matters: When fever occurs, clinicians typically evaluate for infection (including blood counts and cultures), check inflammatory markers (CRP, NLR), and reassess disease status (imaging, fluid analysis) to differentiate paraneoplastic inflammation from treatable infection. ^{[9] [6] [3]}
• Prognostic context: Elevated systemic inflammation (e.g., high CRP or NLR) is linked with worse prognosis in malignant pleural mesothelioma, making fever one possible sign of a broader inflammatory profile. ^{[9] [6] [10]}
• During therapy: A fever ≥38°C during chemotherapy or targeted therapy should prompt immediate contact with the oncology team or emergency care, given the risk of neutropenia or serious lung complications. ^{[3] [11] [13] [4] [12]}

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Practical Guidance for Individuals With Mesothelioma

• If you experience fever (≥38°C), chills, sweats, or feel suddenly unwell, especially while on treatment, seek medical advice promptly to rule out infection and complications. ^{[3] [11] [12]}
• Persistent or recurrent fever outside treatment may reflect paraneoplastic inflammation; discussing tests for CRP, NLR, and other markers with your team can help guide prognosis and care planning. ^{[9] [6] [7]}
• Track associated symptoms like night sweats, weight loss, appetite changes, cough, or shortness of breath, as this information helps your clinician determine whether the fever is primarily inflammation‑driven or infection‑related. ^{[1] [2] [14]}

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Summary Table: Fever in Mesothelioma

Aspect	What it may indicate	Key references
Presence of fever among symptoms	Recognized systemic symptom; less common than respiratory complaints but clinically meaningful	[1] [2] [5]
Paraneoplastic inflammation	IL‑6–driven systemic effects (fever, weight loss); higher CRP/NLR linked to worse outcomes	[8] [9] [6] [7]
Infection during therapy	Potential neutropenic sepsis or lung complications; urgent evaluation for ≥38°C and chills/sweats	[3] [11] [13] [4] [12]
Association with fluid collections/progression	Effusions and peritoneal involvement can accompany fever and systemic symptoms	[14] [15]

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Bottom Line

Fever is a known but variably present symptom in mesothelioma and can reflect either tumor‑related systemic inflammation or intercurrent infection, especially during treatment. ^{[1] [2]} Recognizing the context baseline inflammatory markers, treatment status, and accompanying symptoms helps clinicians determine urgency and tailor management. Any fever ≥38°C in someone receiving mesothelioma therapy should be treated as urgent until infection is ruled out. ^{[3] [11] [12]}