Potential causes of chest pain accompanied by fever in a patient include community-acquired pneumonia, which often presents with chest pain and raised temperature due to infection of the lung tissue. Acute exacerbations of asthma or chronic obstructive pulmonary disease (COPD) can also cause chest pain and fever if there is an infectious trigger. Acute cholecystitis and acute pancreatitis may present with chest or upper abdominal pain and fever due to inflammation. Shingles involving the thoracic dermatomes can cause chest pain with fever if there is systemic involvement. Bornholm's disease (pleurodynia) is another cause characterized by chest pain and fever due to viral infection of the chest wall muscles. Serious cardiac causes such as acute coronary syndrome (ACS) may present with chest pain and fever, especially if complicated by infection or inflammation. Other serious causes include pulmonary embolism, tension pneumothorax, aortic dissection, and ruptured oesophagus, which may be associated with systemic inflammatory response and fever in some cases. Musculoskeletal chest pain is less commonly associated with fever but should be considered if infection or inflammation is present. Dyspepsia and gastrointestinal causes are less likely to cause fever but may coexist with infections causing fever and chest pain.
Clinical assessment including vital signs (respiratory rate, heart rate, blood pressure, oxygen saturation, temperature) and investigations such as chest X-ray and ECG are essential to differentiate these causes and identify serious conditions requiring hospital admission NICE CKS.