Hyperpyrexia leading to death in a patient with severe COVID-19 disease

We describe here the clinical course of a 42 year old male with severe COVID 19 disease treated at a private hospital in Mumbai, India. This patient with very high inflammatory markers at admission was treated with supportive care, mechanical ventilation, anticoagulation, hydroxychloroquine, corticosteroids, tocilizumab, intravenous insulin, antibiotics, sedation and paralysis. There was sustained improvement in his respiratory status and decline in ventilator settings with decline and normalization of CRP, D dimer and PCT. However high fever persisted that did not respond to paracetamol and NSAIDS. On day 8 of admission his axillary temperature touched 107F followed by rapid clinical deterioration and death within the next 12 hours, Blood cultures were consistently sterile. While death was related to hyperpyrexia, the cause of this hyperpyrexia is uncertain.