(1544) Two Cases of "Quad Fever" in Spinal Cord Injury

Introduction: Patients with spinal cord injury (SCI) often experience thermoregulatory and autonomic dysfunction. Some acute patients with SCI show persistent high body temperatures (BT) exceeding 40.8℃ without any identifiable infection, indicating noninfectious causes. Extreme hyperthermia during SCI, termed Quad Fever, has been linked to worsened prognoses, but its mechanism and appropriate treatment remain unclear. In this report, we present a suspected Quad Fever case in a patient with SCI.

Methods: We obtained the medical records of patients with SCI who were transported to our emergency center between 2020 and 2023 and retrospectively evaluated the onset of Quad Fever, prognosis, and organ damage progression in these patients.

Results: Based on the American Spinal Injury Association Impairment Scale (AIS), 16 of the 43 patients with SCI were identified with AIS A or B. Thirteen patients developed fever of 38℃ or higher without any infection, suggesting thermoregulatory dysfunction caused by SCI. Two of these cases (12.5%) were consistent with Quad Fever, with a survival rate of 50%. The patients were 45 and 62 years, and the time to fever onset exceeding 40.8℃ was 5 and 12 days, respectively. Both patients showed ineffective responses to antipyretics and antibiotics, leading to circulatory failure and rapid organ dysfunction.
In the first patient (ISS: 25), the SOFA score increased from 4 to 12 within 24 hours of fever onset, and the BT remained above 42℃, resulting in death approximately 45 hours after onset. In the second patient (ISS: 38), the SOFA score increased from 5 to 13 within 24 hours of fever onset. The use of vasopressors had limited effects on acute circulatory failure. Cytokine adsorption therapy was initiated due to elevated IL-6 levels (822pg/mL), resulting in stabilizing hemodynamics within 12 hours. The patient was survived with persistent consciousness disorders.

Conclusions: Patients with SCI are high risk of thermoregulatory disorders. When fever exceeds 40℃ during treatment, Quad Fever should be considered alongside infection. Prolonged hyperthermia may lead to vascular endothelial damage and worsen outcomes. Hence, if patients with SCI develop fever between 39℃‐40℃, Quad Fever should be considered in mind, and aggressive and strict temperature control should be enforced.