HYPERTHERMIA, RHABDOMYOLYSIS, AND DISSEMINATED INTRAVASCULAR COAGULATION ASSOCIATED WITH BACLOFEN PUMP CATHETER FAILURE

A 29-year-old man with C6 tetraplegia (ASIA A) using an implanted bacl ofen pump and intrathecal catheter infusion system for spasticity cont rol developed severe spasticity, hyperthermia, hypotension, rhabdomyol ysis, and disseminated intravascular coagulation after catheter discon nection. Tracheal intubation and mechanical ventilation were necessary . Extensive workup for a concurrent infection was negative except for urine cultures. The patient remained febrile for 10 days despite empir ical antibiotic trials. Administration of high-dose benzodiazepines wa s inadequate for spasticity control. Spasticity control and his clinic al condition, including body temperature, did not improve until his ca theter was surgically replaced and intrathecal baclofen administration was resumed. The pharmacopathology of abrupt baclofen withdrawal and the similarities between this presentation, sepsis, neuroleptic malign ant syndrome, and malignant hyperthermia are discussed. High-dose dant rolene was not used; however, based on similarities between this patie nt's presentation and neuroleptic malignant syndrome, it may have been the drug of choice. (C) 1998 by the American Congress of Rehabilitati on Medicine and the American Academy of Physical Medicine and Rehabili tation.