A woman in her 30s was hospitalized for suspected anti-NMDA receptor encephalitis. After intravenous administered of haloperidol for restless, her body temperature rapidly increased to the 39℃ level, she developed shock and entered the ICU in an emergency. Sixty mg of dantrolen as a diagnosis for malignant syndrome was intravenously administered. Central cooling with 1 L normal saline fast infusion and surface cooling with Arctic SunTM were performed. Her body temperature reached a maximum of 40.8 ℃, but decreased to 39.2 ℃ in 1 hour after cooling and 38.2 ℃ by 2 hours. Rapid cooling also stabilized hemodynamics. For acute renal injury, temporary continuous hemodiafiltration therapy was performed, but she had not any complications.
Early withdrawal from abnormal hyperthermia and normalization of body temperature was useful because hyperthermia alone can cause multiple organ failure and result in death.
A 49-year-old man with esophageal stenosis by esophageal cancer was treated with a stent insertion. After the procedure, he has had severe chest pain and fever. Four days after stent insertion, sudden hematemesis of about 1000mL with subsequent hemorrhagic shock developed from migration of the stent and esophageal cancer into thoracic aorta and pulmonary hilum. Emergency surgery was performed. Partial esophagectomy and reconstruction, and suture of fistula at pulmonary hilum and thoracic aorta were done with 15000 mL bleeding. He was ventilated in the intensive care unit and was extubated 10 days later. He moved to the ward 12 days after surgery. Aorto-esophageal fistula has high mortality, but this case survived by emergency surgery.