Delayed-Onset Malignant Hyperthermia With Disseminated Intravascular Coagulation Following Successful Prior Anesthetic Use: A Case Report

Malignant hyperthermia (MH) is a serious perioperative reaction associated with exposure to volatile inhalational anesthetics and/or succinylcholine. Severe episodes may lead to widespread physiologic instability, including coagulopathic complications. This case describes an otherwise healthy middle-aged man who developed MH complicated by disseminated intravascular coagulation (DIC) during a subsequent surgery for a left ankle fracture. MH reactions can be unpredictable due to the involved genes' incomplete penetrance, which is why MH does not always occur each time an MH-susceptible patient is exposed to a triggering agent. This case highlights the importance of maintaining vigilance for MH even in patients with prior uneventful anesthetic exposures. Patients with suspected MH reactions should be referred for genetic testing, with important implications for future anesthetic management of both the patient and their family members.