Self-limiting Skin Rash Found in a Patient with Suspected Malignant Hyperthermia Attack - A Case Report

Malignant hyperthermia (MH), a life-threatening complication during general anesthesia, primarily triggers hypermetabolism and skeletal muscle damage. The common MH signs include elevated body temperature, tachycardia, hypercapnia, muscle rigidity, rhabdomyolysis, hyperkalemia, and metabolic acidosis. However, MH-related skin lesions are rarely documented. Here, we present a case of a 3-year-old patient experiencing self-resolving skin rash during an MH episode. A healthy 3-year-old girl underwent strabismus surgery under general anesthesia, displaying the MH episode during the procedure. The significant vital signs included hypercapnia, tachycardia, and hyperthermia, peaking 120 min postinduction. Prompt measures, including sevoflurane discontinuation, hydration, cooling, and alternative anesthesia, swiftly stabilized the patient. Intriguingly, an hour later, an isolated skin rash emerged on the right calf and toes, which gradually resolved without intervention. Postoperative examinations revealed no adverse effects. Despite its rarity, the occurrence of MH-associated skin rashes emphasizes the need for vigilance, especially in pediatric strabismus surgeries, despite minimal documented incidents. In summary, our case highlights the self-limiting nature of MH-related skin rash, occurring post-MH resolution. Its causative mechanisms warrant further investigation. Proactive avoidance of MH trigger agents remains crucial for optimal care during pediatric strabismus surgeries.