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Xylazine is used in veterinary medicine as a sedative, analgesic, and muscle relaxant. However, in recent decades, it has frequently been detected in illicit drugs. Xylazine poisoning is characterized by depression of the central nervous and cardiovascular systems. Herein, we present a case of a 41-year-old man who not only had severe depression of the central nervous and cardiovascular systems, but also developed hyperpyrexia during the treatment of xylazine poisoning, which led to his death 3 days after poisoning. This case indicates that, in addition to its other effects, xylazine may also cause hyperthermia, which has not yet been reported in humans. [ABSTRACT FROM AUTHOR]

Most reported cases of serotonin syndrome involve either a selective serotonin reuptake inhibitor (SSRI) or monoamine oxidase inhibitors (MAOI) and at least 1 other serotonergic medication or exposure to a single serotonin-augmenting drug. This case report describes serotonin syndrome occurring in association with the concomitant use of the antibiotic linezolid and opioids, specifically methadone, in a pediatric intensive care unit patient. The patient developed hyperpyrexia, muscle rigidity, clonus, and multiorgan dysfunction within 48 hours of receiving linezolid while concurrently on methadone. This drug-drug interaction is a rare cause of serotonin syndrome that has only been described 1 other time in the adult literature. This report raises awareness of this rare but serious and potentially lethal complication of serotonin syndrome associated with concomitant linezolid and opioid use. Timely consideration of the diagnosis in the setting of hyperpyrexia can facilitate prompt initiation of targeted therapies to prevent sequela.

Dyskinesia-hyperpyrexia syndrome, a rare medical emergency in Parkinson's disease, is first described in 2010. It is characterized by severe continuous dyskinesia associated with rhabdomyolysis, hyperthermia and subsequent alteration of the mental state. Gradual reduction of dopaminergic dose or DBS is recommended treatment. The prognosis is usually good, but sometimes fatal. But so far, this potentially fatal complication is not widely recognized by clinicians. In emergency, if clinicians fail to make prompt diagnosis and treatment, patients' conditions may get worse, and their lives may be threatened in serious cases. [ABSTRACT FROM AUTHOR]

Abstract Serotonin syndrome (SS) is a rare but potentially life-threatening condition, and it is caused by increasing serotonergic activities. It is an underdiagnosed and under-reported condition. Clinical manifestations can range from mild to moderate to severe symptoms. The intensity of symptoms reflects the degree of serotonin toxicity, and mild serotonin syndrome is easily overlooked by physicians. Severe serotonin toxicity typically occurs to a combination of serotonergic agents. Herein, we describe a case of severe serotonin toxicity in a 38-year-old Egyptian male with a history of generalized anxiety disorder and depression. With increased depressive symptoms, he received 20 mg of fluoxetine daily, and the symptoms developed 1 month after starting fluoxetine, which is the uncommon onset of presentation. The patient was already on tramadol for chronic low backache. The aim is to increase awareness of the syndrome among physicians and neuropsychiatrists.

Abstract Background Infection due to the SARS-CoV-2 virus can have a wide range of presentations from asymptomatic/mildly symptomatic to severe disease with multiorgan failure. Fever is a common symptom. But hyperpyrexia defined as temperature > 41.5 °C is not usual in COVID-19. Case presentation A 24-year-old previously well Sri Lankan female in the 24th week of gestation of her first pregnancy presented with fever and shortness of breath. She was confirmed to have coronavirus disease-2019 (COVID-19). History was suggestive of late presentation on approximately the eighth day of the illness. She had rapidly deteriorating hypoxia due to COVID pneumonia requiring mechanical ventilation two days after the admission. There was evidence of cytokine storm without any secondary bacterial infection. She received glucocorticoids, tocilizumab, and intravenous antibiotics. Although she initially showed mild improvements, she subsequently developed high-grade fever with the axillary temperature rising to 41.7 °C starting from the seventh day of admission. There were no causative medicines or risk factors to explain hyperpyrexia. She died on the ninth day of admission. Conclusions There are no reports of patients developing this complication during pregnancy. The pathophysiology of this rare life-threatening complication remains elusive. Detailed reporting and in-depth analysis of such patients will facilitate the understanding of the associations and successful management of these patients.

Background: Infection due to the SARS-CoV-2 virus can have a wide range of presentations from asymptomatic/mildly symptomatic to severe disease with multiorgan failure. Fever is a common symptom. But hyperpyrexia defined as temperature > 41.5 °C is not usual in COVID-19. Case presentation: A 24-year-old previously well Sri Lankan female in the 24th week of gestation of her first pregnancy presented with fever and shortness of breath. She was confirmed to have coronavirus disease-2019 (COVID-19). History was suggestive of late presentation on approximately the eighth day of the illness. She had rapidly deteriorating hypoxia due to COVID pneumonia requiring mechanical ventilation two days after the admission. There was evidence of cytokine storm without any secondary bacterial infection. She received glucocorticoids, tocilizumab, and intravenous antibiotics. Although she initially showed mild improvements, she subsequently developed high-grade fever with the axillary temperature rising to 41.7 °C starting from the seventh day of admission. There were no causative medicines or risk factors to explain hyperpyrexia. She died on the ninth day of admission. Conclusions: There are no reports of patients developing this complication during pregnancy. The pathophysiology of this rare life-threatening complication remains elusive. Detailed reporting and in-depth analysis of such patients will facilitate the understanding of the associations and successful management of these patients. [ABSTRACT FROM AUTHOR]

Serotonin syndrome (SS) is a rare but potentially life-threatening condition, and it is caused by increasing serotonergic activities. It is an underdiagnosed and under-reported condition. Clinical manifestations can range from mild to moderate to severe symptoms. The intensity of symptoms reflects the degree of serotonin toxicity, and mild serotonin syndrome is easily overlooked by physicians. Severe serotonin toxicity typically occurs to a combination of serotonergic agents. Herein, we describe a case of severe serotonin toxicity in a 38-year-old Egyptian male with a history of generalized anxiety disorder and depression. With increased depressive symptoms, he received 20 mg of fluoxetine daily, and the symptoms developed 1 month after starting fluoxetine, which is the uncommon onset of presentation. The patient was already on tramadol for chronic low backache. The aim is to increase awareness of the syndrome among physicians and neuropsychiatrists. [ABSTRACT FROM AUTHOR]

Perioperative hyperpyrexia raises many questions and can cause permanent brain damage if left untreated. Malignant hyperthermia (MH), although uncommon, but sporadic cases continue to happen and it is potentially life-threatening. It is characterized by sudden rise of body temperatures to above 106° F or even more, and hypercapnia. It is usually associated with anesthetic exposure. However, not every hyperpyrexia is MH; a clinical examination, risk stratification, scoring, and logical approach are required to exclude MH in the postoperative patient. We present a case of rare postoperative hyperpyrexia caused by COVID-19. The patient underwent uneventful spine surgery under general anesthesia and developed hyperpyrexia on the first postoperative day. The case highlights the importance of a logical and systematic approach for excluding the causes of postoperative hyperpyrexia and aggressive management. [ABSTRACT FROM AUTHOR]

Abstract COVID‐19 is a life‐threatening disease complicated by hyperinflammation followed by multi‐organ failure. Although refractory hyperthermia in COVID‐19 contributes to an unfavorable prognosis, little is known about effective interventions. We present a case of successful temperature management using an intravascular cooling device in a patient with COVID‐19 who developed refractory hyperthermia.

Immune checkpoint inhibitors (ICIs) are novel drugs with a dramatic survival benefit in patients with advanced malignancies. With the widespread use, several immune-related adverse events (irAEs) have emerged, which may be life-threatening. Herein we report two patients with adrenal crisis who received anti-programmed cell death protein 1 (PD-1) (pembrolizumab) therapy. Several reports of secondary adrenal insufficiency caused by pembrolizumab exist, including during treatment or late onset. Severe adrenal insufficiency according to the Common Terminology Criteria for Adverse Events (CTCAE) has rarely been described in the literature, since it initially manifests as highgrade fever. The two male patients developed adrenal crisis that was first characterized by hyperpyrexia accompanied by abdominal symptoms. These initial manifestations confused the clinicians who misdiagnosed them as infection. Timely identification, hydrocortisone pulse therapy, and fluid resuscitation improved the patients' condition. Compliance with the standardized treatment approach and course can prevent or relieve the crisis as soon as possible. Assessment of relevant laboratory test results and patient education, including when to use stress-dose hydrocortisone and guidance on route of administration, can reduce the incidence of adrenal crisis. We report these two cases and have evaluated the literature on previously reported cases to improve our understanding of this condition and offer a more scientific approach to diagnosis and treatment options. [ABSTRACT FROM AUTHOR]

Abstract Background Limited data are available for evaluating the relationship between the prognosis and body temperature (BT) in patients treated with mechanical thrombectomy (MT), especially in those with successful recanalization. We aimed to explore the prognostic value of BT in predicting outcomes of stroke recovery at 3 months poststroke. Methods We retrospectively analyzed the relationship among BT levels as a continuous variable, with fever (BT ≥ 37.5℃) as a binary variable, and obtained several outcomes of interest. Subjects were stratified according to successful recanalization (thrombolysis in cerebral infarction scores of 2b-3) following MT. Functional independence was defined as a modified Rankin scale (mRS) score of 0–2. Results In total, 258 patients were included. The proportion of patients with functional independence was significantly lower among patients with BT ≥ 37.5℃ than among those with BT

Given the current context of the SARS-CoV-19 pandemic, among the interfering risky factors with the Aβ peptide aggregation in the brains of Alzheimer’s disease (AD) patients can be hyperpyrexia and increased intracranial pressure (ICP). According to our hypothesis on the relationship between hyperpyrexia and cognitive decline in AD, two models of Aβ peptides were used in this study: the structure of AD amyloid beta-peptide and near-atomic resolution fibril structures of the Aβ peptide. Therefore, the binding templates were constructed for Aβ peptide regions able to bind 9 different metal ions. The fragment transformation method was used for the structural comparison between Aβ chains. Molecular dynamics simulation (MDS) was applied using the Nose-Poincare-Anderson equation to generate a theoretically correct NPT (isothermal–isobaric ensemble). The smallest dissimilarities were observed in the case of Cu+ binding potential followed by Co2+, both with similar variation. Structural changes have also occurred as a result of the dynamic simulation. All these changes suggest an aggravating factor in both hyperpyretic and AD conditions. Our findings suggest that elevated temperature and increased intracranial pressure rise the effect of peptide aggregation, by converting α-helix motif to β-sheet and random coil conformation, which are related to the formation of senile plaques in AD brains.

Abstract Background Patients with severe COVID-19 have disorders of the respiratory, cardiovascular, coagulation, skeletal muscle, and central nervous systems. These systemic failures may be associated with cytokine release syndrome, characterized by hyperpyrexia, thrombocytopenia, hyperferritinemia, and the elevation of other inflammatory markers. Rhabdomyolysis with high fever is a complication that is rarely found in COVID-19. The exact relations of these clinical conditions in patients with COVID-19 remain unknown. Case presentation We present the case of a 36-year-old man with severe COVID-19 complicated by rhabdomyolysis and high fever. After admission, his condition continued to deteriorate, with a high body temperature. On day 9, the patient had elevated creatine kinase and myoglobin levels consistent with rhabdomyolysis (26,046 U/L and 3668 ng/mL, respectively). In addition to viral therapy, he was immediately treated with hydration. However, the patient had persistent fever and elevated creatine kinase levels. The patient was diagnosed with malignant hyperthermia as a late complication of COVID-19, although he had no hereditary predisposition to malignant hyperthermia or neuroleptic malignant syndrome. The administration of dantrolene with muscle relaxation and anti-inflammatory function showed potential efficacy for rhabdomyolysis, high fever, and increased plasma inflammatory markers. Conclusions Malignant hyperthermia is triggered by not only anesthetic agents but also viral infections. A possible mechanism of malignant hyperthermia is hypersensitivity of calcium release from the sarcoplasmic reticulum. These include mutations in or the activation of the skeletal muscle ryanodine receptor calcium release channel. Dantrolene is a ryanodine receptor antagonist and is used as an anti-inflammatory agent. The administration of dantrolene showed potential efficacy for rhabdomyolysis, high body temperature due to inflammation, and increased inflammatory markers. The underlying mechanism of the association of rhabdomyolysis and high fever in COVID-19 might be similar to the pathogenesis of malignant hyperthermia.

COVID‐19 is a life‐threatening disease complicated by hyperinflammation followed by multi‐organ failure. Although refractory hyperthermia in COVID‐19 contributes to an unfavorable prognosis, little is known about effective interventions. We present a case of successful temperature management using an intravascular cooling device in a patient with COVID‐19 who developed refractory hyperthermia. [ABSTRACT FROM AUTHOR]

Background: Misoprostol is a safe drug that is one of the prostaglandins analogs. It has uterotonic solid potential and is good for postpartum hemorrhage (PPH). Misoprostol has some side effects; hyperpyrexia is a rare side effect after misoprostol administration. Cases Report: A 21-year-woman, Gravid 1 Parity 1, 18 hours after cesarean section, suffered from uterus atony and vaginal bleeding that rectal misoprostol was administered. Her PPH was managed with misoprostol and other uterotonics. She developed a fever, and because of the Coronavirus disease (covid-19) pandemic, we suspected it and assayed it, but it was negative. Conclusion: In this rare case, hyperpyrexia occurred after rectal misoprostol administration because of dose and prostaglandin effect on the hypothalamus. In this critical situation that covid-19 is pandemic, we suggest to specialists that keep in mind fever and hyperpyrexia may occur consequently the misoprostol administration. [ABSTRACT FROM AUTHOR]

Background: Limited data are available for evaluating the relationship between the prognosis and body temperature (BT) in patients treated with mechanical thrombectomy (MT), especially in those with successful recanalization. We aimed to explore the prognostic value of BT in predicting outcomes of stroke recovery at 3 months poststroke. Methods: We retrospectively analyzed the relationship among BT levels as a continuous variable, with fever (BT ≥ 37.5℃) as a binary variable, and obtained several outcomes of interest. Subjects were stratified according to successful recanalization (thrombolysis in cerebral infarction scores of 2b-3) following MT. Functional independence was defined as a modified Rankin scale (mRS) score of 0–2. Results: In total, 258 patients were included. The proportion of patients with functional independence was significantly lower among patients with BT ≥ 37.5℃ than among those with BT < 37.5 °C (45.3 % versus 23.0 %; P < 0.001). In the multivariate analysis, hyperpyrexia (especially BT ≥ 38 °C) was significantly associated with poor 3-month outcomes in patients treated with MT. Subgroup analysis was conducted by comparing the successful recanalization group with the non-recanalization group, showing that BT ≥ 37.5 °C was associated with a significantly lower proportion of functional independence in the recanalized patients. Besides, the Kaplan-Meier model showed that the fever group had significantly lower survival rates than the non-fever group during the 3-month follow-up. Conclusions: In patients treated with MT, hyperpyrexia is an independent predictor of poststroke outcomes at 3 months, particularly in those with successful recanalization. [ABSTRACT FROM AUTHOR]

Methamphetamine is one of the most prevalent drugs abused in the world. Methamphetamine abusers usually present with hyperpyrexia (39°C), hallucination and other psychiatric symptoms. However, the detailed mechanism underlying its neurotoxic action remains elusive. This study investigated the effects of methamphetamine + 39°C on primary cortical neurons from the cortex of embryonic Sprague-Dawley rats. Primary cortex neurons were exposed to 1 mM methamphetamine + 39°C. Propidium iodide staining and lactate dehydrogenase release detection showed that methamphetamine + 39°C triggered obvious necrosis-like death in cultured primary cortical neurons, which could be partially inhibited by receptor-interacting protein-1 (RIP1) inhibitor Necrostatin-1 partially. Western blot assay results showed that there were increases in the expressions of receptor-interacting protein-3 (RIP3) and mixed lineage kinase domain-like protein (MLKL) in the primary cortical neurons treated with 1 mM methamphetamine + 39°C for 3 hours. After pre-treatment with RIP3 inhibitor GSK’872, propidium iodide staining and lactate dehydrogenase release detection showed that neuronal necrosis rate was significantly decreased; RIP3 and MLKL protein expression significantly decreased. Immunohistochemistry staining results also showed that the expressions of RIP3 and MLKL were up-regulated in brain specimens from humans who had died of methamphetamine abuse. Taken together, the above results suggest that methamphetamine + 39°C can induce RIP3/MLKL regulated necroptosis, thereby resulting in neurotoxicity. The study protocol was approved by the Medical Ethics Committee of the Third Xiangya Hospital of Central South University, China (approval numbers: 2017-S026 and 2017-S033) on March 7, 2017.

Misoprostol is a synthetic prostaglandin E1 analogue and has been reccommended as a safe, effective, easy to administer, cost efficient next in line drug after oxytocin, for the treatment and prevention of postpartum haemorrhage (PPH). Notwithstanding, it causes certain undesirable side effects compared to oxytocin such as nausea, vomiting, shivering, diarrhoea and transient fever. Transient pyrexia is commonly related with misoprostol administration, due to shift of hypothalamic set point. However, hyperpyrexia clubbed with seizures is a rare yet self-limiting side effect and requires prompt management strategies. There have been case reports describing fever following misoprostol administration but only few describing hyperpyrexia and even fewer describing with seizures. We report a case of hyperpyrexia associated with delayed presentation of generalised sezuires after administration of rectal misoprotol and its successful management in critical care settings.

Background: Patients with severe COVID-19 have disorders of the respiratory, cardiovascular, coagulation, skeletal muscle, and central nervous systems. These systemic failures may be associated with cytokine release syndrome, characterized by hyperpyrexia, thrombocytopenia, hyperferritinemia, and the elevation of other inflammatory markers. Rhabdomyolysis with high fever is a complication that is rarely found in COVID-19. The exact relations of these clinical conditions in patients with COVID-19 remain unknown. Case presentation: We present the case of a 36-year-old man with severe COVID-19 complicated by rhabdomyolysis and high fever. After admission, his condition continued to deteriorate, with a high body temperature. On day 9, the patient had elevated creatine kinase and myoglobin levels consistent with rhabdomyolysis (26,046 U/L and 3668 ng/mL, respectively). In addition to viral therapy, he was immediately treated with hydration. However, the patient had persistent fever and elevated creatine kinase levels. The patient was diagnosed with malignant hyperthermia as a late complication of COVID-19, although he had no hereditary predisposition to malignant hyperthermia or neuroleptic malignant syndrome. The administration of dantrolene with muscle relaxation and anti-inflammatory function showed potential efficacy for rhabdomyolysis, high fever, and increased plasma inflammatory markers. Conclusions: Malignant hyperthermia is triggered by not only anesthetic agents but also viral infections. A possible mechanism of malignant hyperthermia is hypersensitivity of calcium release from the sarcoplasmic reticulum. These include mutations in or the activation of the skeletal muscle ryanodine receptor calcium release channel. Dantrolene is a ryanodine receptor antagonist and is used as an anti-inflammatory agent. The administration of dantrolene showed potential efficacy for rhabdomyolysis, high body temperature due to inflammation, and increased inflammatory markers. The underlying mechanism of the association of rhabdomyolysis and high fever in COVID-19 might be similar to the pathogenesis of malignant hyperthermia. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality, primarily attributed to uterine atony. Both the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) endorse the use of misoprostol not only for the prevention but also for the treatment of PPH. However, the administration of misoprostol is commonly associated with transient pyrexia, attributed to a shift in the hypothalamic set point observed in certain animal studies. Misoprostol-induced hyperpyrexia can occasionally manifest with a prodrome of shivering, particularly when administered via the sublingual route, which achieves a higher and faster maximum plasma concentration compared to vaginal and rectal routes. General management strategies to reduce fever involve removing clothing and blankets, applying cool compresses, administering oral acetaminophen, and ensuring adequate hydration. While some cases have reported misoprostol-induced convulsions, hyperpyrexia leading to convulsions and subsequent rhabdomyolysis is a rare and potentially lethal side effect. In this case presentation, we emphasize a scenario where misoprostol was employed for the treatment of PPH but led to rhabdomyolysis. Our goal is to highlight the side effects of misoprostol and the significance of considering the initial combination of misoprostol with anti-pyretic management to minimize the risk of hyperthermia-related side effects and prevent additional severe complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Li et al.)

Coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a global health emergency, in which its effective treatment and prevention remain obscured. Hyperpyrexia is an elevation of body temperature above 106.7°F (41.5°C) due to an abnormally increased hypothalamic‐thermoregulatory set. The pathophysiology, impact, and outcomes of hyperpyrexia in patients with COVID‐19 have not yet been studied. Herein, we present clinical features and outcomes of six patients with COVID‐19 who had developed hyperpyrexia during hospitalization. All patients expired shortly after the onset of hyperpyrexia. Hyperpyrexia seems to adversely impact the outcomes and mortality in patients with COVID‐19. The underlying mechanisms of developing hyperpyrexia in COVID‐19 are mysterious. We propose it may be caused by SARS‐CoV‐2‐related brain injury, exuberant immune response, and thrombus formation. More research is needed to verify our results. Understanding the association between hyperpyrexia and SARS‐CoV‐2 will help to elucidate the COVID‐19 pathogenesis, which is mandatory for developing effective treatment strategies. Highlights: Hyperpyrexia is a negative prognostic factor for COVID‐19.The pathogenesis of hyperpyrexia in COVID‐19 is undetermined but it may be caused by SARS‐CoV‐2‐related brain injury, exuberant host immune response, and thrombus formation. [ABSTRACT FROM AUTHOR]

• The first case report of a 27 years follow up congenital insensitivity of pain in Indonesia. • Unrecognizing of the clinical pictures in the past, misleads to a late diagnosis and management. • Both patients suffered from debilitating consequence of amputation and death of the male patient. • Open reduction and internal fixations of metaphyseal fractures may eventually lead to non-union. • Diaphyseal fractures more likely result in bony unions with casting immobilization. Congenital insensitivity to pain with anhidrosis (CIPA; OMIM 256,800) is a rare autosomal recessive disease. Although the clinical symptoms are known, the consensus of CIPA treatment has not been recognized. This is the first report of CIPA in Indonesia, a case of two siblings, male and female, whom we followed-up for 27 years. After a series of multiple fractures from an early age, both patients who lived wheelchair-bound with their parents had been suffering from a recurrent debilitating infection on their lower extremities. The male patient eventually died from sepsis due to bronchopneumonia, years after the nonunion of both legs. The female patient underwent double above knee amputation. Observation showed that fracture in joint and metaphysis treated with open reduction ultimately end in disastrous outcomes like infection and non-union. On the contrary, the diaphyseal fracture has a better expectation to unite with casting immobilization. Unrecognizing of the clinical pictures of CIPA and minimal literature references in the past, misleads to late diagnosis and management. Genetic evaluation should be done for infants with unknown causes of high fever, anhidrosis combined with insensitivity to pain. Surgical intervention of metaphyseal fractures should be avoided due to tendencies of implants loosening, metal failures, recurrent infections followed with non-union, and instability. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical characteristics and management of parkinsonism malignant syndrome(PMS) in patients with Parkinsons disease(PD) after deep brain stimulation of the subthalamic nucleus(STN-DBS). Methods The clinical data of 2 patients with PD during STN-DBS occurred to Parkinsonism malignant syndrome were analyzed retrospectively. Results Their clinical features consisted of sustained altered consciousness, rigidity of limbs, dyskinesias, high body temperature and autonomic instability. The vital signs returned to normal, the abnormal movement disappeared and the patients were discharged from hospital in a stable condition after comprehensive treatment including regulation and improvement of DBS stimulation parameters, which may accelerate the patients recovery. Conclusions In perioperative period of DBS should be appropriate to decrease anti-parkinsons drugs. Early recognition and treatment are keys to the successful management, including reducing anti-parkinsons drugs properly. However, once this happen, it is difficult to get back to the baseline. [ABSTRACT FROM AUTHOR]

By definition, "quad fever" is an extreme elevation in body core temperature beyond 40.8°C (105.4°F) in a patient with spinal cord injury. This type of central nervous system hyperpyrexia is seen in spinal cord injury patients, particularly those with high cervical spine injury with quadriplegia. However, it has also been described in paraplegics with a mid- or higher level thoracic spine injury. The incidence of "quad fever" is rare, with the highest reported temperature being 44°C (111.2°F) with chronicled fatal outcomes. Though the use of antipyretics is generally efficacious, they are considerably ineffective in treating the hyperpyrexia seen in this type of severe central autonomic thermodysregulation. Here, we present a case of high cervical spine injury in a 24-year-old male. The trauma resulted in a C3–5 level cord contusion with incomplete quadriplegia (ASIA [American Spinal Cord Injury Association Impairment Scale] grade B). The patient developed high grade fever of 106°F within a week of admission postoperatively. Pancultures were negative and the wound was clean. Despite treatment with higher antibiotics and an infection disease specialist's consult, no obvious etiology was found. Drug-induced fever and thyroid function tests were excluded in other less-common causes. Based on the diagnosis of exclusion, "quad fever" was inferred as the cause. He had other signs of autonomic instability during the episodes such as bradycardia with hypotension. Our patient showed an almost early response to treatment to betablockers and antipsychotics after failure to respond to antibiotics, mechanical hypothermia, and antipyretics. [ABSTRACT FROM AUTHOR]

The COVID- 19 pandemic has been a significant burden on global health care systems leading to over 5 million deaths worldwide and notable increase in morbidity. The second wave of the pandemic in India posed new challenges in the form of increased cases of severe disease, high case loads, younger patients and atypical presentations. It is critical to keep an eye on these unusual cases in order to increase the awareness about varied presentation of this relatively new disease. [ABSTRACT FROM AUTHOR]

Dyskinesia hyperpyrexia syndrome is a rare medical emergency in Parkinson’s disease. It is characterized by continuous dyskinesia associated with hyperthermia, rhabdomyolysis, and alteration of the mental state. We present the case of a 74-year-old woman who presented with recurrent dyskinesia hyperpyrexia syndrome. Although some provocation factors and clinical manifestations seem to be shared with parkinsonism hyperpyrexia syndrome, a clear distinction in management should be considered.

Hypohidrotic ectodermal dysplasia (HED), also known as Christ-Siemens-Touraine syndrome, is a rare X-linked genetic disorder characterized by the faulty development of the ectodermal structures, resulting in most notably anhydrosis/ hypohidrosis, hypotrichosis and hypodontia. Here, we report clinical presentation of a HED case. A female child aged 8 years was brought with complaints of high grade fever along with upper respiratory tract illness symptoms. She also had recurrent episodes of unexplained hyperpyrexia and thirst. Physical examination revealed characteristic appearance which aided in arriving at a diagnosis. Diagnosing this disorder in early life prevents mortality which is high especially during neonatal period. Therefore, it is essential for the treating clinician to have basic knowledge on the clinical presentations as well as complications of this specific genetic disease so that it is not missed. It is rare to see a classical case of hypohidrotic ectodermal dysplasia in female children with typical phenotypic features hence, this case report is presented. [ABSTRACT FROM AUTHOR]

Abstract Ethnopharmacological relevance Pilosocereus gounellei is a plant found in the Brazilian Caatinga and is popular due to its traditional uses in the treatment of inflammation. The present study was conducted to investigate the sub-acute toxicity of the saline extract from the stem of P. gounellei. Aim of the study To evaluate the 28-day oral toxicity (through behavioral, biochemical, hematological, and morphological analysis) and the antipyretic activity of the extract in mice. Materials and methods A single oral dose (250, 500, and 1000 mg/kg) was administered daily over 28 consecutive days to male and female mice. Body weight, food and water intake, blood biochemical and hematological parameters, and urine composition were recorded. Histopathological examinations of the liver, kidney, spleen, lungs, and heart were performed and oxidative stress in the organs was evaluated by lipid peroxidation, superoxide dismutase (SOD), catalase (CAT), and nitrite analysis. The antipyretic effect of the 500 mg/kg dose was assessed using a yeast-induced pyrexia model. Results Oral administration of the extract over 28 days did not affect body weight gain, food and water consumption, body temperature, and hematological parameters in male and female mice. Blood glucose, total cholesterol, and triglyceride levels in male and female mice were reduced. Protein in the urine and histological alterations in both the liver and lungs were detected in male and female mice treated with the highest dose of the extract. SOD levels in the liver and the spleen increased significantly in both sexes, whereas lipid peroxidation decreased in the spleen of male mice. The extract also exerted an antipyretic effect after the first 60 min of the evaluation until the end of the observation duration (180 min). Conclusion The saline extract from the stem of P. gounellei did not present significant toxic effects over 28 consecutive days and demonstrated antipyretic activity when administered orally. Moreover, the results suggest that the extract has potential hypoglycemic and hypolipidemic effects. Future studies are needed to investigate its pharmacological potential. Graphical abstract fx1 [ABSTRACT FROM AUTHOR]

Ramadhan Oruch,1 Ian F Pryme,2 Bernt A Engelsen,3 Anders Lund4 1Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya; 2Department of Biomedicine, 3Department of Clinical Medicine, Section of Neurology, 4Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway Abstract: Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment. Keywords: neuroleptic malignant syndrome, dopamine receptors, rhabdomyolysis, renal shutdown, hyperpyrexia, sarcoplasmic reticulum

Abstract Background Misoprostol has a wide range of applications in obstetrics and gynaecology. It is widely recommended by WHO, FIGO and ACOG for the treatment of postpartum haemorrhage due to it safety and cost-effectiveness. However, usage might be associated to hyperpyrexia and shivering. Case presentation We present a 30 year old Cameroonian female gravida 1 para 1 who had a vaginal delivery at 40 weeks of gestation complicated by primary postpartum haemorrhage (PPH). PPH was managed by sublingual misoprostol that induced shivering and hyperpyrexia managed successfully with paracetamol and cooling. Conclusions The occurrence of fever and shivering should be kept in mind when administering misoprostol for PPH.

Introduction: Hyperpyrexia, algesia and inflammation are pathological disorders which are treated with synthetic as well as herbal medications., Aims: The basic aim of the present study is to evaluate the ethnopharmacological activities of phytoconstituents that are present in C. colocynthis (fruit extract) by using in vivo and in silico studies., Methods: Thirty-six albino rats were used in our studies with an average weight between 150-170 g. Anti-inflammatory activity was investigated using carrageenan (an extract from a red seaweed) that induced edema in albino rat paws. However, in antipyretic and analgesic activity studies, yeast and acetic acid were used to cause pyrexia or algesia, respectively. Different doses of acetone fruit extract were used to treat inflammation, pyrexia and algesia., Results: Our results showed that the maximum percentage inhibition of acetonic fruit extract in anti-inflammatory and analgesic activities was observed at 70% and 100%, respectively, with 400 mg/kg doses, and in pyretic activity the maximum inhibitory percentage was 86% with a 100 mg/kg dose. In in silico analysis, we have shown that bioactive compounds (α-spinasterol, ascorbic acid and chlorogenic acid) found in fruit extract have outstanding inhibition properties that involves proteins PTGS2, TLR2 and TRPV4. C. colocynthis fruit extract shows results that are statistically significant (p < 0.005) and comparable to a reference drug. Acetonic fruit extract of C. colocynthis can be used as a natural and safe remedy with no side effects., Conclusion: Both in vivo and in silico studies on chlorogenic acid, ascorbic acid and α-spinasterol have shown that these are inhibitory compounds that can be used for boosting the immune response., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially life-threatening complication of the management of Parkinson's disease (PD). Central hypodopaminergic state which results due to abrupt withdrawal of dopaminergic medications in patients with PD is the postulated cause. Clinical manifestations of PHS are very akin to neuroleptic malignant syndrome (NMS). Here, we report a case of a 60-year-old male with 13-year history of PD, who was on Levodopa (300 mg) + Carbidopa (75 mg). On abrupt stoppage of Levodopa (300 mg) + Carbidopa (75 mg), he presented with symptoms akin to NMS, with raised creatine kinase. As soon as the antiparkinsonian medications are reinstituted, the patient recovered completely. Literature in this area is limited to few case reports only. Existing literature recommends prompt reinstitution of antiparkinsonian medications as the mainstay of therapy for patients presenting with PHS. [ABSTRACT FROM AUTHOR]

Aim: Dyskinesia-hyperpyrexia syndrome is a rare case of medical emergency in Parkinson's disease caused by excessive dopaminergic stimulation. It is characterized with severe continuous dyskinesias associated with rhabdomyolysis, hyperthermia, and subsequent alteration of the mental state. The aim of this paper is to present a clinical case of a patient with Parkinson's disease presenting with dyskinesia and hyperpyrexia. Case report: We present a case of a 55-year-old patient who presented with high body temperature and worsening of dyskinesia that lasted for 15 days. The patient, despite a detailed clinical examination and laboratory examination, was unidentified as such. In the further course of the treatment, the condition of the patient deteriorated in the sense of extreme hyperpyrexia with the development of respiratory insufficiency and circulatory instability. Aft er four weeks of treatment in the Intensive Care Unit, the patient passed away with severe autonomic dysfunction. Conclusion: This case emphasizes the importance of early recognition of dyskinesia and hyperpyrexia as an emergency in Parkinson's disease with the aim of early medical support and prevention of life-threatening consequences. [ABSTRACT FROM AUTHOR]

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08-11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364-1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30-35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5-14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future. [ABSTRACT FROM AUTHOR]

Background: Scoliosis is a common deformity in patients with neuromuscular disorders which usually necessitates surgical correction. Patients with neuromuscular scoliosis are characterized by increased incidence of associated medical co-morbidities and higher postoperative complication rate; therefore, these patients are often managed with a wide multidisciplinary care team. Postoperative fever is a frequent complication after surgery which is often routinely investigated using different workup tests to rule out infection. These tests lack clear evidence on how they impact the patient care and are associated with increased cost and burden on the health system.Objective: The objective of our study was to evaluate the incidence of postoperative fever after surgical correction of neuromuscular scoliosis and evaluate the clinical usefulness of fever diagnostic workup.Methods: Demographic and clinical data on patients who underwent neuromuscular scoliosis corrective surgery between March 1, 2014 and February 28, 2017 were reviewed at a single institution. The occurrence of postoperative fever (defined by body temperature ≥ 38 °C during the 1st week after surgery) was characterized by maximum temperature (T max), postoperative day of occurrence (POD), and frequency as described by either single or multiple temperature spikes. The diagnostic tests performed for the assessment of postoperative fever were reviewed. The cost per health effect was calculated by dividing the total costs of performed fever workup tests by the number of tests that resulted in change of the patient care.Results: Seventy-six patients (47 females and 29 males) were identified. Cerebral palsy was the most common aetiology in 40 patients (52.6%). The mean age at surgery was 13.5 years (range 3-18 years). The operative time was 490.34 ± 127.21 min. The intraoperative blood loss was 912.3 ± 627.8 cc. The hospital stay was 9.79 ± 5.3 days and the intensive care unit (ICU) stay was 3.26 ± 3.7 days. Wound drains were used in 71 patients for a period of 3.6 ± 2.3 days. Urinary catheters were used for a period of 3.6 ± 1.8 days. Forty-nine patients (64.5%) developed postoperative fever with a temperature of 38.7° ± 0.45° (range 38.10°-39.9°). The most frequent POD for occurrence of fever was the 2nd day in 22 patients (44.9%) The frequency of fever was in the form of multiple temperature spikes in 32 patients (65.3%) or in the form of a single spike in 17 patients (34.7%). There were a total of 20 positive tests out of 132 performed fever workup tests (15.2%). These included nine positive urine analysis (n = 32), five positive urine cultures (n = 28), one positive blood culture (n = 23), and two positive chest X-ray (n = 24). The occurrence of postoperative fever was statistically correlated with the operative time and increased hospital stay and ICU days. The most common identified cause of infection was urinary tract infection in 11 patients followed by respiratory tract infection in four patients and wound infection in one patient. The calculated cost per health effect was $3763.Conclusion: Sixty-four percent of patients who underwent surgical correction of neuromuscular scoliosis developed postoperative fever. Postoperative fever was sign of infection in 32.7% of patients and urinary tract infection was the most frequent finding. Only 15.2% of fever diagnostic workup tests were positive. Diagnostic urine tests account for 70% of the positive diagnostic workup. The routine use of blood cultures for the assessment of postoperative fever in such population should be avoided due to the low rate of positive tests and the associated high cost. [ABSTRACT FROM AUTHOR]

Introduction: Hyperpyrexia is a severely elevated core body temperature secondary to an elevated hypothalamic set thermo-regulatory threshold. Hyperthermia is an elevated core body temperature beyond the normal hypothalamic set thermo-regulatory threshold. Intracranial hypotension can present with a wide variety of symptoms ranging from orthostatic headache up to coma. We report a rare case of hyperpyrexia associated with intracranial hypotension.Methods: A case report of a 55-year-old female patient with a history of angiogram-negative subarachnoid hemorrhage status post-ventriculoperitoneal (VP) shunt placement six years prior to admission who suddenly developed encephalopathy and high fever. Conventional management of the fever was unsuccessful.Results and Management: Brain magnetic resonance imaging revealed signs of significant intracranial hypotension. When the VP shunt was tapped, no cerebrospinal fluid (CSF) could be obtained. Once the VP shunt settings were adjusted, the patient's encephalopathy and hyperpyrexia resolved.Conclusion: Hyperpyrexia might be a presenting symptom of intracranial hypotension, likely, secondary to hypothalamic dysfunction and compression. In our case, hyperpyrexia was reversible as the intracranial hypotension was emergently treated. Spontaneous intracranial hypotension might be difficult to diagnose, especially if it presented with non-classical symptoms like fever; thus, physicians should be aware of such association. [ABSTRACT FROM AUTHOR]

It is not clear if children with high fever are at increased risk for serious bacterial infection (SBI). Our aim was to systematically review if children suffering from high fever are at high risk for SBI. Our data sources were Embase, Medline, and Pubmed; from their inception until the last week of March 2017. The study selection were of cohort and case control studies comparing the incidence of SBI in children with hyperpyrexia with children with fever of 41 °C or less, and children with a temperature higher than 40 °C, with children with fever of 40 °C or less. Two reviewers independently pooled studies for detailed review using a structured data-collection form. We calculated the odds ratio and 95% confidence intervals (CI) for SBI, assuming a random-effects model. A sub-group analysis was conducted. In our results, 11 studies met the inclusion criteria. Two studies showed that children with hyperpyrexia are at higher risk for SBI (OR 1.96 95% CI 1.3-1.97). An increased risk for SBI in children with high fever (OR 3.21 95% CI 1.67; 6.22). SBI in infants with temperature over 40 °C was higher compared to infants with lower degree of fever (OR 6.3 95% CI 4.44; 8.95). On older children, the risk for SBI was only slightly higher in children with fever above 40 °C. The limitation of the study is the small amount of studies and that the heterogeneity of the studies was very high.Conclusion: Young infants with temperature higher than 400 °C are at increased risk for SBI. Risk of SBI in older children with temperature > 400C is minimal. What is known: • An association between high fever and increased risk for SBI was reported in young infants. • Based on only two studies from the 1970s and 1980s, hyperpyrexia is associated with increased risk for SBI. What is new: • Infants under the age of 3 months with fever > 40 °C were found to have increased risk for SBI. • Risk of SBI in older children with temperature > 40 °C is minimal. [ABSTRACT FROM AUTHOR]

Background: A burn injury results in the release of proinflammatory cytokines and catecholamines, causing a hypermetabolic state which may lead to hyperpyrexia (>40 °C). This risk is increased with concomitant sepsis. Hyperpyrexia is associated with a high mortality. Continous veno-venous haemodiafiltration (CVVHDF) can be used to reduce the circulating cytokines thereby reducing the cause of the hyperpyrexia. CVVHDF use has been well documented in sepsis and SIRS in the ITU population. In our Burns Centre, CVVHDF is routinely used to treat patients with persistent hyperpyrexia. The aim of this study was to evaluate the role of CVVHDF in burns patients with hyperpyrexia. Methods: A retrospective analysis was carried out of all patients admitted to the Burns ITU between 2005 and 2012 who received CVVHDF for hyperpyrexia. The medical notes and electronic database was used to collect data on indication, renal function, duration and outcome. Results: Five hundred seventy patients were admitted over the time period. Sixty-one patients received CVVHDF overall and of these 32 were for hyperpyrexia alone. In these patients, there was a significant reduction in temperature within 3 h of initiating CVVHDF ( p < 0.0001). The cumulative predicted mortality using Modified Baux score was seven patients. In our group 2 patients died, possibly implying a survival benefit. Conclusions: CVVHDF can be successfully used to regulate the temperature in burns patients with hyperpyrexia. Level of evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Misoprostol, a synthetic prostaglandin E1 has wider application in obstetrics gynaecology. It has been recommended in the prophylaxis and treatment of Post Partum Haemorrhage (PPH) by Federation of Obstetrics and Gynaecology (FIGO), World Health Organisation (WHO) and American College of Obstetrics and Gynaecology (ACOG). It is a very safe drug associated with transient side-effects like fever, chills, nausea, vomiting, diarrhoea and abdominal pain. In the present case report patient had an unusual side effect of hyperpyrexia and convulsion after use of misoprostol for prophylaxis against PPH.

Background: Pyrexia is a physiological response through which the immune system responds to infectious processes. Hyperpyrexia is known to be neurodegenerative leading to brain damage. Some of the neurotoxic effects of hyperpyrexia on the brain include seizures, decreased cognitive speed, mental status changes, coma, and even death. In the clinical management of hyperpyrexia, the goal is to treat the underlying cause of elevated temperature and prevent end organ damage.Case Presentation: This case illustrates a 39-year-old white American man referred from another medical facility where he had undergone an upper gastrointestinal tract diagnostic procedure which became complicated by blood aspiration and respiratory distress. During hospitalization, he developed a core body temperature of 41.6 °C (106.9 °F) leading to cognitive decline and coma with a Glasgow Coma Score of 3. Levetiracetam and amantadine were utilized effectively for preserving and restoring neurocognitive function. Prior studies have shown that glutamate levels can increase during an infectious process. Glutamate is an excitatory neurotransmitter that is utilized by the organum vasculosum laminae terminalis through the neuronal excitatory system and causes an increase in body temperature which can lead to hyperpyrexia. Similar to neurogenic fevers, hyperpyrexia can lead to neurological decline and irreversible cognitive dysfunction. Inhibition of the glutamate aids a decrease in excitatory states, and improves the brain's regulatory mechanism, including temperature control. To further improve cognitive function, dopamine levels were increased with a dopamine agonist.Conclusions: We propose that a combination of levetiracetam and amantadine may provide neuroprotective and neurorestorative properties when administered during a period of hyperpyrexia accompanied by any form of mental status changes, particularly if there is a decline in Glasgow Coma Score. [ABSTRACT FROM AUTHOR]