BMJ Case Reports 2017; doi:10.1136/bcr-2017-219937
  • Reminder of important clinical lesson

QUAD fever: beware of non-infectious fever in high spinal cord injuries

  1. Raj Kumar Mani2
  1. 1Internal Medicine, Nayati Medicity Mathura, Mathura, India
  2. 2Pulmonology Critical Care, Nayati Multisuperspeciality Hospital, Mathura, India
  1. Correspondence to Dr Raj Kumar Mani, raj.rkmjs{at}
  • Accepted 29 May 2017
  • Published 18 June 2017


A case of cervical spinal cord injury and quadriparesis with prolonged fever is being described. Initially, the patient received treatment for well-documented catheter-related bloodstream infection. High spiking fever returned and persisted with no obvious evidence of infection. The usual non-infectious causes too were carefully excluded. QUAD fever or fever due to spinal cord injury itself was considered. The pathogenetic basis of QUAD fever is unclear but could be attributed to autonomic dysfunction and temperature dysregulation. Awareness of this little known condition could help in avoiding unnecessary antimicrobial therapy and in more accurate prognostication. Unlike several previous reported cases that ended fatally, the present case ran a relatively benign course. The spectrum of presentations may therefore be broader than hitherto appreciated.


  • Contributors JG was involved in all stages of manuscript preparation and online submission of the paper. RJ was involved in literature search and collecting radiology films. PB was involved in collection of data. RKM was involved editing of the draft and final preparation of case reports.

  • Competing interests None declared.

  • Patient consent Obtained from next of kin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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