Fatal hyperthermia following acute cervical spinal cord and head injury

A 22-year-old man with schizophrenia presented with cervical spine damage caused by a crush injury. Upon admission, we performed anterior cervical decompression and fusion of vertebrae C5, C6, and C7. The patient experienced treatment-resistant hyperthermia with a body temperature >40°C. He did not show any evidence of drug use that might induce malignant hyperthermia. He also did not exhibit symptoms of common forms of malignant hyperthermia, including rigidity of the arms and legs, myo. globin in the urine, or anesthesia toxicity. The patient’s condition did not improve, and he died of hypotension 15 hours after admission. We speculate that the cause of death was malignant hyperthermia due to acute cervical spinal cord injury. The physiological origin of hyperthermia in this patient is unknown. Recognition of hyperthermia symptoms and risk factors in patients with cervical spinal cord injury may enable early intervention to prevent progression to fatal fever.