Severe hyperthermia due to oral baclofen withdrawal

Abstract

We report a case of a 53-year-old woman who presented initially with sepsis and later in her stay developed a severe and rapidly progressing hyperthermia after a decrease in oral baclofen dosage. Her fever peaked at 42.5○C (108.5○F), creating a broad differential diagnosis and complicating her initial sepsis diagnosis. When the oral baclofen dose was increased, the fevers resolved which confirmed the clinical diagnosis of baclofen withdrawal. Dose reductions of oral baclofen should be made gradually and with caution, and patients should be monitored for fevers as a possible symptom of baclofen withdrawal.

Baclofen therapeutics, toxicity, and withdrawal: A narrative review

“…General treatment principles of baclofen withdrawal include frequent vital sign monitoring, avoidance of dehydration, support of cardiopulmonary function, management of associated symptoms such as seizures and delirium, and most importantly, re-initiation or supplementation of baclofen dosing. 74 , 85 , 103 Hydration with intravenous fluids is important to prevent and treat the effects of rhabdomyolysis. 104 Given the potential for rapid decompensation, it is recommended that patients being managed for baclofen withdrawal be admitted to an ICU for close monitoring of their hemodynamics and respiratory status.…”