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Malignant hyperthermia-like syndrome associated with metrizamide myelography.

Malignant hyperthermia (MH) is a potentially fatal syndrome occurring during or after anesthesia conducted with potent inhalation anesthetics agents and/ or succinylcholine (1). Fever is the most distinctive sign and is usually accompanied by severe acidosis, tachycardia, tachypnea, and muscle rigidity. We report a case of a life threatening reaction to an intrathecal injection of metrizamide (Amipaque), a nonionic, iodinated, water-soluble contrast media, after anesthesia conducted with MH triggering anesthetics. Because fever, acidosis, and muscle hypertonicity suggested a diagnosis of MH, dantrolene therapy was instituted. However, subsequent muscle biopsy and testing with halothane and caffeine failed to substantiate the diagnosis. With increased suspicion of MH, it is important to recognize that not all postoperative fevers are caused by MH and that successful management requires a careful consideration of other possibilities after initial treatment of suspected MH proves unresponsive to therapy.