Management of Suspected Neuroleptic Malignant Syndrome

1995 ◽  
Vol 40 (9) ◽  
pp. 545-550 ◽  
Author(s):  
Vr Velamoor ◽  
Gn Swamy ◽  
Late-Rs Parmar ◽  
P Williamson ◽  
Sn Caroff
Keyword(s):  
Risk Factors ◽  
Neuroleptic Malignant Syndrome ◽  
Early Recognition ◽  
Case Reports ◽  
Differential Diagnoses ◽  
Rational Approach ◽  
Review Of The Literature ◽  
Drug Induced ◽  
Induced Hyperthermia ◽  
Treatment Data

Objective Neuroleptic Malignant Syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia. The objective of this paper is to provide data regarding early and suspected cases as well as offer guidelines for managing this condition. Knowledge of suspected cases will lead to early recognition and prompt management of this condition in the future. Method To address the gap in knowledge, we present 2 case reports of patients with early NMS-like symptoms. The case reports are followed by a brief review of the literature on differential diagnoses, risk factors, early signs and treatment data. Conclusions The most rational approach to treating NMS entails a hierarchy of interventions determined by the severity and progression of symptoms.

scholarly journals Antimicrobial-induced cognitive side effects

2016 ◽  
Vol 6 (4) ◽  
pp. 207-214 ◽  
Author(s):  
Amanda Warstler ◽  
Jennifer Bean
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Side Effects ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Time Frame ◽  
Drug Induced ◽  
Pubmed Search ◽  
Neuropsychiatric Side Effects ◽  
Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

scholarly journals Lichen Planus Pemphigoides Induced by Enalapril: A Case Report and a Review of Literature

2017 ◽  
Vol 9 (3) ◽  
pp. 217-224 ◽  
Author(s):  
Woranit Onprasert ◽  
Kumutnart Chanprapaph
Keyword(s):  
Lichen Planus ◽  
Early Recognition ◽  
Case Reports ◽  
Direct Immunofluorescence ◽  
Drug Induced ◽  
First Case ◽  
Bullous Dermatosis ◽  
Culprit Drug ◽  
History Of ◽  
Hands And Feet

Lichen planus pemphigoides (LPP) is a rare autoimmune bullous dermatosis. The clinical presentation of LPP may mimic bullous pemphigoid making the diagnosis difficult. A thorough clinical, histopathological, and immunological evaluation is essential for the diagnosis of LPP. The etiology is largely idiopathic; however, there are several case reports of drug-induced LPP. We report an 81-year-old Thai woman with underlying hypertension and type 2 diabetes mellitus who presented with a 4-week history of multiple tense bullae initially on the hands and feet that subsequently expanded to the trunk and face. Enalapril was commenced to control hypertension. The histopathology and direct immunofluorescence were compatible with LPP. Circulating anti-basement antibodies BP180 was also positive. The patient was treated with topical corticosteroid with a modest effect. Enalapril was discontinued and complete resolution of LPP occurred within 12 weeks. There was no recurrence after a 1-year follow-up period. To the best of our knowledge, we present the first case of enalapril-induced LPP. Early recognition and prompt discontinuation of the culprit drug allow resolution of the disease. Medication given for LPP alone, without cessation of the offending drug, may not change the course of this condition.

scholarly journals Dexamethasone Associated ST Elevation Myocardial Infarction Four Days after an Unremarkable Coronary Angiogram—Another Reason for Cautious Use of Steroids: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Mohamed Shokr ◽  
Ahmed Rashed ◽  
Kusum Lata ◽  
Ashok Kondur
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Spasm ◽  
St Elevation Myocardial Infarction ◽  
Coronary Angiogram ◽  
Review Of The Literature ◽  
Drug Induced ◽  
St Elevation ◽  
Traditional Risk Factors ◽  
Artery Disease

Drug induced myocardial infarction is a known entity with different forms of steroids linked to coronary artery disease (CAD) either through promoting its traditional risk factors, inducing coronary spasm, or by other unidentified mechanisms. Dexamethasone is known to promote an atherogenic and hypercoagulable state. We report a case of a 75-year-old woman who had ST elevation myocardial infarction (STEMI) associated with dexamethasone use just 4 days following an angiogram showing minor luminal irregularities.

scholarly journals An unusually impressive atorvastatin-induced elevation of serum alkaline phosphatase

2020 ◽  
Vol 13 (2) ◽  
pp. e231839 ◽  
Author(s):  
George Chapman ◽  
Stephanie Tanner
Keyword(s):  
Alkaline Phosphatase ◽  
Statin Therapy ◽  
Serum Alkaline Phosphatase ◽  
Early Recognition ◽  
Case Reports ◽  
Competitive Inhibitor ◽  
Assessment Method ◽  
Drug Induced ◽  
Similar Drug ◽  
The Uk

A 90-year-old woman is referred six months after a transient ischaemic attack (TIA) with asymptomatic cholestatic liver function test (LFT) derangement. Following the TIA, atorvastatin and clopidogrel therapy are initiated. This is added to pre-existent once daily nifedipine for hypertension. Nifedipine (a weak inhibitor of CYP3A4 and competing substrate) and clopidogrel (a competitive inhibitor of CYP3A4) may have affected the metabolism of atorvastatin, resulting in the elevation of serum alkaline phosphatase levels to over six times the upper limit of normal. More often, statin therapy elevates serum alanine aminotransferase levels. Drug-induced liver injury (DILI) was deemed ‘probable’ as judged by the Roussel Uclaf Causality Assessment Method score. Statin therapy remains overwhelmingly safe, with benefits outweighing risks in the vast majority. The UK recommended LFT monitoring regime facilitates early recognition of DILI. Case reports are examined where similar drug combinations resulted in severe morbidity and mortality.

scholarly journals TL 18094 - Fluorquinolones and the risk of Achilles tendon disorders

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 77S
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Miguel Srougi ◽  
Homero Bruschini ◽  
Cesar de Cesar Netto ◽  
Lucas Furtado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Achilles Tendon ◽  
Case Reports ◽  
Tendon Injury ◽  
Achilles Tendinopathy ◽  
The Body ◽  
Current Evidence ◽  
Drug Induced ◽  
Concurrent Use ◽  
Associated Risk Factors

Introduction: Achilles FQ-associated tendinopathy was first reported by Bailey et al. in 1983. Since then, nearly 200 case reports related to FQ-associated tendon injury have been published, as well as some case control and cohort studies. Today, drug-induced tendinopathy is accepted as a class effect of FQ. The Achilles tendon is affected in 90% of cases of FQ-related tendinopathy and rupture. Objective: To evaluate current evidence for the association between fluoroquinolones and Achilles tendinopathy and to identify associated risk factors that increase the incidence of this complication. Methods: We conducted a computerized search of the relevant scientific literature from 1988 to 2018 using electronic databases, including PubMed, Medline and Scopus. The search terms were fluoroquinolone-related tendinopathy. Eligible studies were any available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture); animal and human histologic studies were included. Data collected included any cases of fluoroquinolone-related tendinopathy, the particular tendon affected, type of FQ, dosage, and concomitant risk factors. Results: The references selected were reviewed by all authors and judged based on their contribution to the body of knowledge on this topic. The conduct and validity of any clinical studies were carefully considered, and the outcomes of management protocols were carefully scrutinized. Case reports mentioning a specific association with the condition that were thought to be relevant to the discussion were included. Only papers that made a significant contribution to understanding of this condition were included in the review. Thus, a total of 560 abstracts were screened, 79 of which were directly related to FQ-associated Achilles tendinopathy or tendon rupture. Conclusion: The association between the use of fluoroquinolone antibiotics and Achilles tendon disorders is well-established in the medical literature. We found that male gender, advanced age, normal BMI, chronic renal failure and concurrent use of corticosteroids increases the risk of Achilles tendon pathology. Caution should be exercised during the utilization of this antibiotic class in patients with these characteristics

scholarly journals Acquired digital fibrokeratoma: A case report and review of the literature

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Su Li ◽  
Xin Li ◽  
Fu-lun Li ◽  
Bin Li
Keyword(s):  
Case Report ◽  
Literature Search ◽  
Case Reports ◽  
Ring Finger ◽  
Differential Diagnoses ◽  
Review Of The Literature ◽  
Patient Demographics ◽  
History Of ◽  
Slow Growing

<p>Acquired digital fibrokeratoma (ADFK) has typical characteristics and occurs most frequently on the fingers. The size of the tumor is usually less than 1 cm in diameter. We report a case of a typical ADFK, along with a review of the literature. A 76-year-old man presented with a two-year history of a slow-growing keratotic tumor on the edge aspect of his right hand ring finger. A literature search was conducted to identify published case reports of ADFK. Data on patient demographics, size and location of the lump, treatment, and follow-up were collected from each case report. This case is of interest because of the rarity of ADFK. Additionally, we have emphasized the importance of ruling out other causes of abnormal growths and considering fibrokeratoma during differential diagnoses.</p>

scholarly journals Neuroleptic Malignant Syndrome or Catatonia? A Case Report

2020 ◽  
Vol 6 (3) ◽  
pp. 190-193
Author(s):  
Sebastian Rodriguez ◽  
Keith A. Dufendach ◽  
Robert M. Weinreib
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Marked Improvement ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Life Saving ◽  
Intravenous Diazepam ◽  
Autonomic Instability

AbstractIntroductionA review of the literature has shown that there are many similarities in the presentation of neuroleptic malignant syndrome (NMS) and catatonia. Attempts to reconcile the differences have been made by suggesting that NMS and catatonia may represent different presentations of the same illness or that they lie within the same spectrum of a poorly understood clinical syndrome. The described case is of a patient who presented with NMS and catatonia which was difficult to diagnose, but which responded to treatment with intravenous diazepam.Case presentationThe case concerns a 22-year-old male admitted for pulmonary hypertension to an intensive care unit (ICU). Three days following admission, he developed a high fever that did not respond to antibiotics. The patient then developed rigidity, nocturnal agitation, decreased responsiveness, and somnolence. Without the use of bromocriptine (Novartis, Basel, Switzerland) or dantrolene (Par Pharmaceuticals, Chestnut Ridge, USA) discontinuation of neuroleptics combined with intravenous diazepam (Pfizer, NY, USA) led to a very rapid response and marked improvement in the case.ConclusionsEarly recognition and management of NMS and MC in a complex, gravely ill patient, may be accomplished in the ICU despite obfuscation of traditional signs and symptoms of the NMS and MC syndrome. Such interventions can have life-saving effects on patients in danger of fatal autonomic instability.

scholarly journals Bupropion Induced Hyponatremia in an Elderly Patient: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Sahil Munjal ◽  
Yvette Smolin
Keyword(s):  
Risk Factors ◽  
Elderly Patient ◽  
Psychiatric Illness ◽  
Major Depressive Episode ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Review Of The Literature ◽  
Major Depressive ◽  
Additional Risk ◽  
Low Bmi

We present the case of a 72-year-old female with a major depressive episode who developed hyponatremia associated with bupropion. In reviewing the literature, there are only a few case reports which pertain to this topic. The clinical symptoms of hyponatremia can be misinterpreted as a worsening of the primary psychiatric illness and can lead to potentially serious consequences if not fully evaluated. We recommend that clinicians should be well aware of this side effect and that sodium levels should be checked within the first 2 weeks after initiating treatment in patients, especially those with additional risk factors for hyponatremia, such as older age, female sex, diuretic use, low BMI, and unexplained mental status changes at any time during treatment with antidepressants. The risk for hyponatremia associated with mirtazapine appears to be low and its use can be helpful in patients who have developed hyponatremia induced by other antidepressants and who experienced symptoms of weight loss and insomnia.

Major symptoms and differential diagnosis of neuroleptic malignant syndrome: three case reports

2000 ◽  
Vol 15 (5) ◽  
pp. 334-337 ◽  
Author(s):  
C. Védie ◽  
F. Poinso ◽  
F. Hemmi ◽  
B. Rivet
Keyword(s):  
Differential Diagnosis ◽  
Neuroleptic Malignant Syndrome ◽  
Autonomic Dysfunction ◽  
Extrapyramidal Symptom ◽  
Case Reports ◽  
Review Of The Literature

SummaryThe authors describe the cases of three patients presenting a major extrapyramidal symptom with rising CPK, inconstant hyperthermia and autonomic dysfunction. Through a brief review of the literature, the authors question the unity of the malignant syndrome. If hypertonia is quite constant, the rise in the seric CPK is aspecific and hyperthermia is inconstant.

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