Fatal hyperthermia triggered by drug-induced fever in a patient with high-level spinal cord injury: a case report.

We report a rare fatal hyperthermic crisis likely precipitated by drug-induced fever in a muscular, obese patient with chronic high-level spinal cord injury (SCI). Shortly after antibiotic therapy was changed to meropenem, the patient developed severe agitation and hyperthermia exceeding 41 °C, accompanied by autonomic instability. Despite intensive management, including active cooling, intravenous fluids, and vasoactive support, the core temperature remained above 41 °C. Computed tomography revealed a low-density brainstem lesion consistent with infarction. The patient experienced respiratory arrest and died 4 h after admission to the ICU. This case underscores the complex interplay between drug-induced fever, impaired thermoregulation due to SCI, and heat-retentive body composition. This case highlights the risk of rapid and disproportionate temperature elevation in patients with high-level SCI, even in response to relatively minor fever-provoking stimuli, due to impaired thermoregulation. Early recognition and prompt intervention are crucial to prevent fatal hyperthermic crises in this vulnerable population.