More Insidious Development and Fulminant Malignant Hyperthermia: A Case Report

Email: dr.luiz.imbelloni@gmail.com; luiz.imbelloni@edu.inca.gov.br ABSTRACT Background: Malignant hyperthermia (MH) is a pharmacogenetic condition, secondary to exposure to inhalational anesthetics and succinylcholine and related to the exacerbated release of calcium in the myoplasm, leading to hypermetabolism and rhabdomyolysis. The classical clinical presentations are of rapid onset and evolution. This case describes an MH atypical presentation. Case Report: Male, 41 years old, 85 kg, brown, admitted for a hepatic tri-segmentectomy to treat a Klatskin’s tumor. Surgery was performed under balanced general anesthesia with sevoflurane and epidural block. The patient presented with hyperthermia, profuse sweating, need for a progressive increase in minute ventilation to control etCO2 values, metabolic lactic acidosis, and hyperkalemia, progressing to circulatory shock. The acute condition was controlled with dantrolene and supportive measures, but there was progression to death after one week. Conclusion: This case showed a rare presentation of MH. Despite having a slow and insidious onset, that progressed with greater severity than reported in other cases, culminating in the patient’s death on the 7th postoperative day.