Quad fever after traumatic spinal cord injury resolved by naproxen: a case report

Abstract

We herein present a case of quad fever after traumatic spinal cord injury. A 60s man had multiple trauma including head, high spinal cord, thorax and intraperitoneal organ, extremity caused by a traffic accident. ICU day 1, emergent abdominal operation and amputation of lower leg were performed and spinal fusion was operated at ICU day 9. Since ICU day 2, hyperthermia continued even though we administered some broad-spectrum antibiotics. Blood, urine cultures were negative, wound infection wasn’t admitted and thyroid function tests was normal. Diagnosis of the etiology of hyperthermia was challenging, and active extracorporeal cooling by failed to lower temperature. However, the cyclooxygenase (COX)-2 inhibitor naproxen alleviated fever. Quad fever, that is defined hyperthermia after spinal cord injury, is not caused by known infectious or noninfectious agents and is difficult to control, does not respond to most treatment approaches, and may sometimes be fatal. Detailed mechanism underlying quad fever remains unclear. Effective treatment of quad fever has not been established, but COX-2 inhibitors such as naproxen might be effective in controlling quad fever.