Fever and thromboembolic disease in acute spinal cord injury

Thromboembolic Disease (T.E.D.) is a major cause of morbidity and mortality in the first few months following spinal cord injury. The purpose of this three year retrospective study is to delineate the previously poorly described role of fever as both a common component of T.E.D. manifestation and, on occasion, the sole presenting sign of an otherwise occult T.E.D. process. We reviewed 148 consecutive admissions to the Southeastern Michigan Spinal Cord Injury System (1982-1985). Ten patients with documented T.E.D. were found and extensively reviewed; 3 had inadequate documentation of clinical manifestations and 1 patient was found from venography to have a non-acute thrombosis. Of the remaining 6 cases, all had fever as a sign, and 4 of these patients had fever as the sole presenting sign. Full fever work-ups were performed in each case and no other source for fever could be found. Fever spikes occurred most commonly at night, with a maximum temperature of 100.2 degrees F (oral) to a high in one case of 103.0 degrees F (oral). All fevers resolved within the first week of adequate anticoagulation therapy. These findings indicate that fever may be the earliest and, possibly, only clinical sign of an otherwise occult T.E.D. process.