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VOLUME 22 , ISSUE 1 ( 2018 ) > List of Articles


Quad fever: Treatment through lowering of ambient temperature

Shyam Krishnan, Pulak Nigam, Omar Bachh, Madabushi Vasudevan

Keywords : Hyperpyrexia, paraparesis, quad fever, spinal cord injury, thermoregulation

Citation Information : Krishnan S, Nigam P, Bachh O, Vasudevan M. Quad fever: Treatment through lowering of ambient temperature. Indian J Crit Care Med 2018; 22 (1):43-45.

DOI: 10.4103/ijccm.IJCCM_295_17

License: CC BY-ND 3.0

Published Online: 01-05-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Hyperpyrexia is a rare and at times fatal condition seen in an Intensive Care Unit setup. We encountered a case of a 65-year-old patient with road traffic accident presenting with dorsal spine fracture at D10level. He underwent decompression and fusion for the same. He developed hyperpyrexia of sudden onset on the 10th day of admission with no source of infection and adequate broad-spectrum antibiotic coverage with adequate thrombo-embolic prevention in place. The patient showed no response to antipyretic agents and other cooling methods. The origin of hyperthermia was idiopathic, and we speculate that the cause was secondary to hyperthermic thermoregulatory dysfunction often quoted as “quad fever,” seen in spinal cord injury. We present a brief review of literature and the importance of early identification and treatment of this potentially fatal condition.

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  1. Demuro JP, Mongelli MN, Hanna AF, Cunha BA. Extreme hyperpyrexia with cervical spinal cord injury: Survival using an external pad based hypothermia protocol. Inj Extra 2013;44:51-3.
  2. Hirata J, Ohya M, Kumon K. Fatal hyperthermia following acute cervical spinal cord and head injury. Crit Care Shock 2014;17:96-9.
  3. Tripathy S, Whitehead CF. Endovascular cooling for severe hyperthermia in cervical spine injury. Neurocrit Care 2011;15:525-8.
  4. Ulger F, Dilek A, Karakaya D, Senel A, Sarihasan B. Fatal fever of unknown origin in acute cervical spinal cord injury: Five cases. J Spinal Cord Med 2009;32:343-8.
  5. Dalal S, Zhukovsky DS. Pathophysiology and management of fever. J Support Oncol 2006;4:9-16.
  6. Ganong WF. Review of Medical Physiology. 22nd ed. New York: McGraw-Hill Medical; 2005.
  7. Lepock JR. Cellular effects of hyperthermia: Relevance to the minimum dose for thermal damage. Int J Hyperthermia 2003;19:252-66.
  8. Sugarman B, Brown D, Musher D. Fever and infection in spinal cord injury patients. JAMA 1982;248:66-70.
  9. Kras JV, Dong L, Winkelstein BA. Increased interleukin-1α and prostaglandin E2 expression in the spinal cord at 1 day after painful facet joint injury: Evidence of early spinal inflammation. Spine (Phila Pa 1976) 2014;39:207-12.
  10. Knochel JP, Goodman EL. Heat stroke and other forms of hyperthermia. In: Mackowiak PA, editor. Fever: Basic Mechanisms and Management. 2nd ed. Philadelphia: Lippincott-Raven; 1997.
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