1251 - Poikilothermia in Spinal Cord Injury, Pediatric to Geriatric: 2 Case Reports

Case 1:

2-year-old male with complex past medical history including an in-utero hematoma causing thoracic spinal cord compression and spinal cord injury. Patient repeatedly presented to the ED with hypothermia, had multiple negative infectious workups, seen by PM&R consult team one admission. Due to concomitant facial flushing and sweating above the upper thoracics, as well as bradycardia and presence of noxious stimuli, his hypothermia was diagnosed as a part of his autonomic dysfunction.

Case 2:

69-year-old male, past medical history of incomplete spinal cord injury at C4, admitted to inpatient rehabilitation due to debility after VZV meningitis. He was persistently hypothermic with multiple negative infectious workups and other vitals consistent with autonomic dysfunction. He failed environmental modifications, so was started on progesterone 200mg daily for poikilothermia,


Discussions: Poikilothermia is a form of autonomic dysfunction seen in persons with spinal cord injury (SCI) with a lesion at or above T8. Temperature abnormalities are generally managed with environmental modification. However, when these measures are insufficient there is limited research as to what providers should utilize next. Research in SCI has examined hypothermia as a treatment for acute SCI, but there are minimal options for the treatment of hypothermia itself.  There has been one previous case report of using progesterone for hypothermia.

Conclusions: These 2 cases demonstrate 2 different presentations of poikilothermia: one pediatric patient with intermittent hypothermia as the presenting symptom of his autonomic dysfunction, and an adult patient with persistent hypothermia that was treated with progesterone It is important to both learn to identify poikilothermia in SCI patients, as well as continue to explore treatment options, as this is an area of limited study as of yet.