Fever, infection, or both occurred at some time during hospitalization in 67% of patients on a referral spinal cord injury service. A single cause of fever was generally found, with urinary tract and soft-tissue infections predominating; these responded well to appropriate management. In contrast, spinal cord injury patients on other services seen in consultation by the infectious disease service had far more complicated and advanced disease. Multiple infections were diagnosed in the majority of these patients, with urinary tract and decubitus ulcers predominating. Complicating osteomyelitis was present in more than half of those who had infected decubitus ulcers. In both groups of patients, diagnosis required careful attention to physical and laboratory examination because multiple potentially infected areas could be identified and because usual symptoms were sometimes masked by altered sensation.