WITHDRAWN

Abstract

SESSION TITLE: Critical Care of Immunocompromised Patients Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Hyperpyrexia is defined as a core body temperature greater than 41.5 °C or 106.7°F. In modern times, hyperpyrexia is most prevalent in central nervous system hemorrhages. It can be seen in severe bacterial infections, though uncommon in modern times. Other more common causes of severe hyperthermia can include heat stroke and drug toxicity. This case presents a much less obvious cause of hyperpyrexia. CASE PRESENTATION: 27-year-old previously healthy female presents dysarthria and aphasia. Vitals revealed a temperature of 106.8 °F. Patient was admitted to ICU. Initial laboratory evaluation revealed renal failure, liver failure, rhabdomyolysis, troponin leak and hemolytic anemia. Nephrology started dialysis. MRI brain showed focal area of restricted diffusion involving the splenium of the corpus callosum. A CT chest/abdomen/pelvis showed no acute abnormalities. The patient's GCS deteriorated and was intubated. Rheumatology and hematology were consulted. High dose steroids were started. Due to high suspicion for an autoimmune process, the patient underwent plasmapheresis. Work-up revealed multiple positive autoimmune serologies. Extensive infectious workup was negative. the patient was extubated and kidneys began to recover. Renal biopsy revealed active focal and membranous lupus nephritis, ISN/RPS III + V. A diagnosis of severe lupus flare was made. Mycophenolate was initiated at this time. Steroids were tapered. The fever decreased but never resolved. She was then transferred to a tertiary center for biologics. DISCUSSION: Systemic Lupus Erythematosus is a relatively common autoimmune disease that involves multiple organ systems. Fever is a common manifestation of SLE and can occur in 36–86% of patients (1). According to the 2019 EULAR/ACR criteria, Fever is a low weighted diagnostic criterion for SLE. However, lupus flare fever is usually low-grade, rarely exceeding 102 F (2). The patient was found to be negative for infection, drug toxicity, heat stroke, intracranial bleed, hypothalamic infarct, or large vessel occlusion. It was therefore postulated that the biopsy proven acute SLE flare caused the hyperpyrexia. However, it is unclear if the entirety of the poly organ failure was caused by autoimmune reaction with organs themselves or by the hyperpyrexia. Only the Lupus Nephritis was confirmed by biopsy. Temperature of 38.5°C in non-infected patients result in increased mortality and adverse outcomes. (3). In this case, we presume that most of the patient's poly-organ dysfunction was either caused or perpetuated by hyperpyrexia. The full extent that the fever contributed to any specific organ dysfunction cannot be concretely demonstrated. CONCLUSIONS: This case demonstrates that in patients with hyperpyrexia or severe hyperthermia, autoimmune etiology should not be overlooked. This case presents a previously healthy, young female with hyperpyrexia caused solely by severe lupus flare. Reference #1: 1. Falagas ME, Manta KG, Betsi GI, Pappas G. (2007). Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol, 26: 663– 670. Reference #2: 2. Bernatsky S, Boivin JF, Joseph L, et al. (2006). Mortality in systemic lupus erythematosus. Arthritis Rheum, 54: 2550– 2557. Reference #3: 3. Edward Walter, Oliver R. Gibson. (2020). The efficacy of steroids in reducing morbidity and mortality from extreme hyperthermia and heatstroke—A systematic review. Pharmacol Res Perspect. 2020; 8:e00626 DISCLOSURES: No relevant relationships by Syed Akbarullah No relevant relationships by Sara Alleyasin No relevant relationships by Kory Cummings No relevant relationships by LLOYD Del Mundo No relevant relationships by Gerard DiChiara No relevant relationships by Jerome Hruska No relevant relationships by Amber McDonald No relevant relationships by Xenia Schneider No relevant relationships by Paul Stewart