[Apyretic malignant hyperthermia. Apropos of a case]

Area of Science:

• Anesthesiology
• Pharmacology
• Oral and Maxillofacial Surgery

Background:

• Malignant hyperthermia (M.H.) is a rare, life-threatening pharmacogenetic disorder of skeletal muscle.
• It is primarily triggered by volatile anesthetics and succinylcholine during surgical procedures.
• Recurrent traumatic bone cysts of the mandible are typically benign but require surgical intervention.

Observation:

• A patient undergoing surgery for a recurrent traumatic bone cyst of the mandible developed malignant hyperthermia crisis.
• The crisis presented with fever but notably lacked muscle rigidity, a common M.H. symptom.
• This atypical presentation highlights the variable clinical manifestations of M.H.

Findings:

• Malignant hyperthermia crisis can manifest without the classic signs of muscle rigidity and fever.
• Early recognition and aggressive therapeutic intervention are crucial for managing M.H. crisis.
• Successful management of a febrile M.H. crisis was achieved in this case.

Implications:

• Clinicians should maintain a high index of suspicion for M.H. crisis, even with atypical presentations.
• Aggressive and timely treatment can avert fatal outcomes in M.H. crisis.
• This case underscores the importance of preparedness for rare adverse drug reactions in surgical settings.