Abstract

Central fever is a non-infectious, neurogenic hyperthermia arising from thalamic injury. It complicates the clinical course of patients in neurointensive care units by closely mimicking infectious sepsis, often leading to diagnostic dilemmas and the inappropriate overuse of broad-spectrum antimicrobials.The underlying mechanism involves the disruption of hypothalamic thermoregulatory pathways and secondary neuroinflammation. Emerging advanced neuromonitoring techniques further assist in differentiating autonomic dysregulation from infection. We present the clinical course of two neurocritically ill patients who developed refractory central fever. The report discusses successful resolution of fever in these patients. Maintaining a high clinical suspicion for central fever following the systematic exclusion of sepsis is paramount. Prompt intervention with targeted therapies like diclofenac rapidly controls temperature, safeguards the brain from secondary metabolic stress, and prevents antimicrobial abuse.

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