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Fatal malignant hyperthermia--delayed onset and atypical course.

B Karger1, K Teige

  • 1Institute of Legal Medicine, University of Münster, Röntgenstrasse 62, 48149 Münster, Germany. karger@uni-muenster.de

Forensic Science International
|October 10, 2002
PubMed
Summary

Malignant hyperthermia (MH) can present atypically, even without muscle rigidity. This case highlights a protracted MH course leading to death, complicated by sepsis, underscoring diagnostic challenges.

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Area of Science:

  • Anesthesiology
  • Pathology
  • Toxicology

Background:

  • Malignant hyperthermia (MH) is a severe pharmacogenetic disorder of skeletal muscle.
  • Triggered by volatile anesthetics and succinylcholine, MH presents with hypermetabolism and muscle rigidity.

Observation:

  • A 27-year-old man experienced elevated end-tidal CO(2) and body temperature during two separate anesthetic procedures.
  • Despite symptoms, masseter spasms or muscle rigidity were absent.
  • The patient died 10 days after the second anesthesia, with death attributed to sepsis and multi-organ failure.

Findings:

  • Postmortem examination revealed skeletal muscle necrosis, myoglobinuria, and myoglobin clots.
  • Histological findings supported a diagnosis of malignant hyperthermia.

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  • The atypical and protracted clinical course, alongside suspected sepsis, complicated the diagnosis and legal proceedings.

    • Implications:

    • This case demonstrates that malignant hyperthermia can manifest with atypical signs and a prolonged course.
    • Differentiating MH from sepsis in complex cases is crucial for accurate diagnosis and patient management.
    • The findings emphasize the importance of comprehensive postmortem analysis in establishing definitive diagnoses.