Can compartment syndrome cause hyperpyrexia?

Compartment Syndrome and Fever

Compartment syndrome itself does not cause a fever of 105°F (hyperpyrexia), but severe cases can lead to systemic complications like rhabdomyolysis and reperfusion injury that may cause high fevers. 1

Pathophysiology of Compartment Syndrome

Compartment syndrome occurs when increased pressure within a fascial compartment compromises blood flow, leading to:

• Tissue ischemia and potential necrosis
• Nerve damage
• Muscle damage
• Potential systemic complications

The primary symptoms and signs include:

• Pain out of proportion to injury (earliest sign)
• Paresthesia (sensory changes)
• Tension/firmness of the compartment
• Pain with passive stretch
• Late signs: pallor, pulselessness, paralysis 1, 2

Relationship Between Compartment Syndrome and Fever

Primary Causes of Fever in Compartment Syndrome

1. Rhabdomyolysis

   • Muscle breakdown releases myoglobin and creatine phosphokinase
   • Can cause systemic inflammatory response
   • May lead to fever, though typically not as high as 105°F 1

2. Reperfusion Injury

   • After revascularization or fasciotomy
   • Release of oxygen-free radicals creating leaky capillary process 3
   • Systemic inflammatory response can cause fever

3. Secondary Infection

   • Necrotic tissue can become infected
   • Can progress to sepsis with high fever
   • More common in delayed treatment cases 3

Differential Diagnosis When Seeing High Fever with Compartment Syndrome

A fever of 105°F with compartment syndrome should prompt investigation for:

1. Sepsis/Septic Shock

   • Particularly if compartment syndrome has been present for some time
   • May present with hypotension requiring vasopressors
   • Elevated lactate levels 3

2. Necrotizing Fasciitis

   • Can mimic or coexist with compartment syndrome
   • Causes severe systemic toxicity and high fevers
   • Requires immediate surgical intervention 1

3. Systemic Inflammatory Response Syndrome (SIRS)

   • From severe tissue damage and rhabdomyolysis
   • Can cause fever, though 105°F would be unusually high 4

Management Implications

When a patient presents with compartment syndrome and high fever:

1. Immediate Surgical Consultation

   • Fasciotomy should not be delayed 1
   • The American College of Cardiology recommends fasciotomy within 6 hours of onset to prevent irreversible damage 3, 1

2. Aggressive Fluid Resuscitation

   • Maintain urine output >2 ml/kg/hr
   • Alkalinize urine if myoglobinuria is present 1

3. Broad-Spectrum Antibiotics

   • Particularly if infection is suspected
   • Should cover skin and soft tissue pathogens 3

4. Monitor for Multi-Organ Dysfunction

   • Compartment syndrome with high fever may indicate progression to multi-organ failure
   • Monitor renal function, coagulation status, and electrolytes 4

Key Pitfalls to Avoid

1. Attributing the fever solely to compartment syndrome

   • A fever of 105°F is not typical of uncomplicated compartment syndrome
   • Always search for infection or other causes

2. Delaying fasciotomy to investigate fever

   • Surgical decompression should not be delayed for diagnostic workup when compartment syndrome is clinically evident 1

3. Inadequate fluid resuscitation

   • Patients with compartment syndrome and fever are at high risk for acute kidney injury
   • Aggressive fluid therapy is essential 4

4. Missing compartment syndrome in febrile patients

   • Fever may distract from the diagnosis of compartment syndrome
   • Maintain high suspicion in at-risk patients with extremity pain 2

In summary, while compartment syndrome itself typically does not cause extreme hyperpyrexia (105°F), the presence of such a high fever in a patient with compartment syndrome should raise concern for serious complications like sepsis, necrotizing infection, or severe reperfusion injury requiring immediate intervention.