Acute and Critical Care

Case Reports

Neurology
Myoclonic status epilepticus after severe hyperthermia in a patient with coronavirus disease 2019: Katherine A Hill, John J Peters, Sara M Schaefer; Acute Crit Care. 2023;38(4):509-512. Published online March 24, 2022; DOI: https://doi.org/10.4266/acc.2021.01452

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Abstract PDF: Myoclonic status epilepticus (MSE) is a sign of severe neurologic injury in cardiac arrest patients. To our knowledge, MSE has not been described as a result of prolonged hyperpyrexia. A 56-yearold man with coronavirus disease 2019 presented with acute respiratory distress syndrome, septic/hypovolemic shock, and presumed community-acquired pneumonia. Five days after presentation, he developed a sustained fever of 42.1°C that did not respond to acetaminophen or ice water gastric lavage. After several hours, he was placed on surface cooling. Three hours after fever resolution, new multifocal myoclonus was noted in the patient’s arms and trunk. Electroencephalography showed midline spikes consistent with MSE, which resolved with 40 mg/kg of levetiracetam. This case demonstrates that severe hyperthermia can cause cortical injury significant enough to trigger MSE and should be treated emergently using the most aggressive measures available. Providers should have a low threshold for electroencephalography in intubated patients with a recent history of hyperpyrexia.

Neurology
Malignant Syndrome in Parkinson Disease Similar to Severe Infection: Dong Hun Lee, Jeong Mi Moon, Yong Soo Cho; Korean J Crit Care Med. 2017;32(4):359-362. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00087

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A 70-year-old woman with Parkinson disease was admitted to the emergency department with altered consciousness, fever and convulsive movements without experiencing withdrawal from antiparkinsonian medication. Six hours after the emergency department visit, the patient had a hyperpyrexia (>40°C) and a systolic blood pressure of 40 mmHg. There was no evidence of bacterial infection based on extensive workups. The patient was discharged without aggravation of Parkinson disease symptoms after treatment that included administration of dantrolene sodium, enforcement of continuous renal replacement therapy and cooling blankets. Malignant syndrome should be suspected if high fever occurs in Parkinson disease patients without evidence of a definitive infection.

Citations

Citations to this article as recorded by

Parkinsonism-Hyperpyrexia Syndrome and Dyskinesia-Hyperpyrexia Syndrome in Parkinson’s Disease: Two Cases and Literature Review
Jian-Yong Wang, Jie-Fan Huang, Shi-Guo Zhu, Shi-Shi Huang, Rong-Pei Liu, Bei-Lei Hu, Jian-Hong Zhu, Xiong Zhang
Journal of Parkinson's Disease.2022; 12(6): 1727. CrossRef

Review

Hematology
Severe Fever with Thrombocytopenia Syndrome: Seung Jin Yoo, Sang Taek Heo, Keun Hwa Lee; Korean J Crit Care Med. 2014;29(2):59-63. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.59

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Abstract PDF

Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease, caused by a novel species of Phlebovirus of Bunyaviridae family, in China, South Korea, and Japan. SFTS is primarily known as a tick-borne disease, and human-to-human transmission is also possible in contact with infectious blood. Common clinical manifestations include fever, thrombocytopenia, and leukopenia as initial symptoms, and multiple organ dysfunction and failure manifest with disease progression. Whereas disease mortality is reported to be 12% to 30% in China, a recent report of cumulative SFTS cases indicated 47% in Korea. Risk factors associated with SFTS were age, presence of neurologic disturbance, serum enzyme levels, and elevated concentrations of certain cytokines. Diagnosis of SFTS is based on viral isolation, viral identification by polymerase chain reaction, and serologic identification of specific immunoglobulin G. Therapeutic guideline has not been formulated, but conservative management is the mainstream of treatment to prevent disease progression and fatal complications.

Citations

Citations to this article as recorded by

The first discovery of severe fever with thrombocytopenia syndrome virus in Taiwan
Tsai-Lu Lin, Shan-Chia Ou, Ken Maeda, Hiroshi Shimoda, Jacky Peng-Wen Chan, Wu-Chun Tu, Wei-Li Hsu, Chi-Chung Chou
Emerging Microbes & Infections.2020; 9(1): 148. CrossRef
Epidemiology of severe fever and thrombocytopenia syndrome virus infection and the need for therapeutics for the prevention
Norbert John C. Robles, Hae Jung Han, Su-Jin Park, Young Ki Choi
Clinical and Experimental Vaccine Research.2018; 7(1): 43. CrossRef
Two Treatment Cases of Severe Fever and Thrombocytopenia Syndrome with Oral Ribavirin and Plasma Exchange
In Park, Hye In Kim, Ki Tae Kwon
Infection & Chemotherapy.2017; 49(1): 72. CrossRef

Original Article

Causes of Fever in the ICU - A Prospective, Cohort Study: Eun Ju Jeon, Hye Min Lee, Sung Gun Cho, Hyung Koo Kang, Hee Won Kwak, Ju Han Song, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim; Korean J Crit Care Med. 2008;23(1):13-17.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.13

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Abstract PDF

BACKGROUND
Fever develops in 70% of ICU patients. In the present study, we tried to figure out causes of fever and the prognosis of febrile patients in the ICU in a prospective, cohort method.
METHODS
From February to June 2007, patients admitted to medical ICU were daily screened and those who developed fever were enrolled. 237 consecutive admissions of 237 patients over a 5-month period were analyzed. Clinical parameters, including demographic data, underlying diseases, duration of ICU stay, causes of fever and final outcome were analyzed.
RESULTS
Fever (core temperature > or =38.3degrees C) was present in 8% of admission, and it was caused by infective (84.2%) and non-infective processes (15.8%). Most fever occurred within first 5 days in the course of the admission (68.4%) and most lasted less than 5 days (57.9%). The median Acute Physiology and Chronic Health Evaluation (APACHE) III score at the time of fever was 43 (+/-19). Those with infectious fever had no significant differences in terms of severity of diseases in comparison with those with non-infectious cause of fever. The most common cause of infective fever was pneumonia (n=11). Prolonged fever (> or =5 days), all of which was caused by infection, occurred in 11 patients. Those with prolonged fever had higher mortality rate than short duration of fever (37.5% vs 0%, p<0.05).
CONCLUSION
Infection, especially pneumonia is common cause of fever in the ICU. Prolonged fever is associated with high mortality rate.

Citations

Citations to this article as recorded by

The Value of Procalcitonin and the SAPS II and APACHE III Scores in the Differentiation of Infectious and Non-infectious Fever in the ICU: A Prospective, Cohort Study
Eun Ju Jeon, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Ae Ja Park, Jae Yeol Kim
Journal of Korean Medical Science.2010; 25(11): 1633. CrossRef

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