Malignant hyperthermia in severe COVID-19: 2 case reports

Abstract

Malignant hyperthermia is a rare but potentially fatal condition. We present 2 cases of young patients with coronavirus disease 2019 (COVID-19) requiring intubation for hypoxic respiratory failure who both developed significant hyperthermia post intubation and were suspected to have malignant hyperthermia. However, the 2 patients had different responses to conservative management and dantrolene. These cases highlight the increased challenge imposed by intubation complications when managing patients with COVID-19.

Dantrolene and ryanodine receptors in COVID‐19: The daunting task and neglected warden

“…Ehteshami‐Afshar et al 118 reported two cases of malignant hyperthermia in patients with COVID‐19 following intubation and administration of succinylcholine. One patient responded to DTN therapy, whereas the second one did not, which could be because of drug‐induced fever or adrenal insufficiency 118 . Therefore, DTN, which is a pioneer for malignant hyperthermia, could be beneficial in the management of malignant hyperthermia/hyperpyrexia in COVID‐19.…”

“…116 Hyperpyrexia in COVID-19 is because of immune dysregulation, acute brain injury and thrombotic disorders that together increase the threshold of the hypothalamic-thermoregulatory centre. 19,116,117 Ehteshami-Afshar et al 118 reported two cases of malignant hyperthermia in patients with COVID-19 following intubation and administration of succinylcholine. One patient responded to DTN therapy, whereas the second one did not, which could be because of drug-induced fever or adrenal insufficiency.…”

“…One patient responded to DTN therapy, whereas the second one did not, which could be because of drug-induced fever or adrenal insufficiency. 118 Therefore, DTN, which is a pioneer for malignant hyperthermia, could be beneficial in the management of malignant hyperthermia/hyperpyrexia in COVID-19.…”