An uncommon cause of sepsis in patients with large burns is occult intracompartmental infection. A multi-institution review of 1171 burn admissions identified 5 patients (0.4%) who developed intracompartmental sepsis presenting with fever and purulent drainage or fever, erythema swelling on clinical examination. Contributing factors may have included high-volume resuscitation, delayed escharotomy, extravasated intraosseous infusion, cannulation-related arterial injury splinting or positioning diffculties. A high index of suspicion and an aggressive surgical approach facilitate successful management of this unusual problem.