Quad Fever After a Traumatic Cervical Spinal Cord Injury: Diagnostic Challenges and Therapeutic Response to...

Quad fever is a rare, potentially fatal form of neurogenic hyperpyrexia occurring after high cervical or upper thoracic spinal cord injury (SCI) and is frequently misdiagnosed as severe infection. It is characterised by extreme, non-infectious hyperthermia resulting from autonomic and central thermoregulatory dysfunction. We report the case of a previously healthy 72-year-old woman who sustained a traumatic C4-C5 SCI and developed abrupt postoperative hyperpyrexia (40.9 °C) within 12 hours of anterior cervical decompression and fusion. Despite antipyretics, broad-spectrum antibiotics, and physical cooling, daily high-grade fevers persisted. An extensive evaluation excluded infectious, inflammatory, endocrine, neoplastic, and hardware-related causes, with normal inflammatory markers and sterile cultures. Based on the clinical context and exclusion of alternative etiologies, a diagnosis of quad fever was established. Enteral bromocriptine 5 mg twice daily was initiated based on its dopaminergic modulation of hypothalamic thermoregulation, resulting in complete defervescence within 24 hours and sustained apyrexia thereafter, without adverse effects. This allowed the patient to continue a structured rehabilitation programme and be discharged in good general condition. This case underlines quad fever as a diagnosis of exclusion in patients with severe SCI and refractory fever, illustrates the potential morbidity and resource use associated with delayed recognition, and supports the role of bromocriptine as a promising therapeutic option.