SUMMARY

We report a case of a 53-year-old woman who presented initially with sepsis and later in her stay developed a severe and rapidly progressing hyperthermia after a decrease in oral baclofen dosage. Her fever peaked at 42.5^○C (108.5^○F), creating a broad differential diagnosis and complicating her initial sepsis diagnosis. When the oral baclofen dose was increased, the fevers resolved which confirmed the clinical diagnosis of baclofen withdrawal. Dose reductions of oral baclofen should be made gradually and with caution, and patients should be monitored for fevers as a possible symptom of baclofen withdrawal.

Background

Baclofen, a centrally acting gamma-aminobutyric acid (GABA) derivative, reduces endogenous neurotransmitter release by binding to the GABA (b) receptors at the presynaptic terminals.1 Its clinical effect is the prevention of hyperreflexia, involuntary muscle movement and decreased muscle tone.2 Hence, baclofen is one of the most frequently used agents to control the spasticity in spinal cord injury.1 Oral baclofen does not readily cross the blood-brain barrier, which is why its benefits in spinal cord injury are typically attained through high oral doses averaging from 60 mg/day to 300 mg/day, or through intrathecal administration where it is directed at the site of action.3–5

Withdrawal of intrathecal baclofen is a well-documented medical emergency. Oral baclofen withdrawal can also lead to significant side effects such as agitation, delirium, altered mental status, dyskinesia, tachycardia and seizures.6 Few case reports link oral baclofen to high fevers and autonomic dysfunction.5–7 We …