Hot and Cold: Malignant Hyperthermia Without Fever in a Burn Patient

Malignant hyperthermia (MH) is a rare, lifethreatening condition typically characterized by a rapid increase in body temperature and muscle rigidity in response to anesthetics. However, patients with extensive burn injuries have impaired thermoregulation and intraoperative heat loss, which can mask this classic hyperthermic response. We present the case of a 38-year-old female with a 23% total body surface area flame burn who developed a severe MH crisis during tangential excision following exposure to sevoflurane. Despite profound hypercapnia, acidosis, hyperkalemia, and extremity rigidity, the patient remained entirely afebrile throughout the event. Prompt recognition of the crisis by the surgical and anesthesia teams, followed by immediate administration of dantrolene, led to a rapid reversal of her metabolic derangements and a successful recovery.