Acute Exacerbation of Fever Following Administration of Tropicamide and Phenylephrine Ophthalmic Solution: A Case Report

A 24-year-old woman with atopic dermatitis and persistent fever (axillary temperature of 37–38 °C for 6 months) received combination ophthalmic drops containing tropicamide and phenylephrine (Mydrin(®)-P), which exacerbated her fever within 15 min after instillation. Her axillary fever reached 40.1 °C but resolved the following day. No new dermatological symptoms developed. Although the patient’s fever may have been caused by either tropicamide or phenylephrine, neither of which have been reported to induce fever in topical formulations, atopic dermatitis and tropicamide’s inhibitory effect on perspiration under hot and humid conditions may have been the more probable cause. While drug-induced fever has been reported for other ophthalmic anticholinergic agents, this is the first reported case of possible fever exacerbation by an ophthalmic formulation of tropicamide, if the causative agent is assumed to be tropicamide.