1133 - Postoperative Spiking Fever Diagnosed as Central Fever from Cerebrospinal Fluid Leak: A Case Report

The patient presented with progressive bilateral upper extremity numbness and lower extremity weakness. Imaging revealed severe cervical spondylotic myelopathy due to extensive posterior longitudinal ligament ossification, multilevel neuroforaminal narrowing, and C1-T1 disc osteophytes. He underwent C1-T1 laminectomy and C4-C7 corpectomy and discectomy with fusion. Intraoperatively, a CSF leak was identified. A lumbar drain was attempted postoperatively, but subsequent imaging showed an ICH in the right occipital lobe, later extending to the right temporal region. The patient developed quadriplegia and spiking fever, ranging from 36.8°C to 39.4°C. Despite broad-spectrum antibiotics, the fever persisted. White blood cell count remained normal while procalcitonin was elevated. Viral testing, blood cultures, and CSF cultures were negative. CSF leak was confirmed by beta-2 transferrin-positive fluid collection. Given the clinical context and lack of infectious source, central fever was suspected. Initiation of bromocriptine 1.25mg twice daily led to resolution of the fever on the same day.

Discussions:

Postoperative fever is frequently presumed to be infectious. Although central fever is well-reported in traumatic brain injury or large hemorrhages, it is rarely recognized after spine surgery complicated by CSF leak and remote intracranial hemorrhage. Early diagnosis of central fever in patients with neurologic injury and unexplained fever can prevent unnecessary antibiotic use and facilitate timely treatment. Bromocriptine, a dopamine agonist, may serve both diagnostic and therapeutic roles in such cases.

Conclusions:

Central fever should be considered after cervical spine surgery with CSF leak and intracranial hemorrhage when fever is unresponsive to antibiotics.