scholarly journals Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription

2017 ◽  
Vol 5 ◽  
pp. 2050313X1769599 ◽  
Author(s):  
Thomas J Reilly ◽  
Sean Cross ◽  
David M Taylor ◽  
Richard Haslam ◽  
Sophie C Tomlin ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Adverse Drug Reaction ◽  
Pulmonary Embolism ◽  
Neuroleptic Malignant Syndrome ◽  
Kidney Injury ◽  
Clinical Suspicion ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Intravenous Fluids ◽  
Life Threatening

Objectives: To describe a case of neuroleptic malignant syndrome following antipsychotic treatment of catatonia, highlighting the potentially serious complications of this rare adverse drug reaction. Methods: We present a case report of a patient who developed this syndrome with various sequelae. Results: The patient developed neuroleptic after being treated with lorazepam and olanzapine for catatonia. He subsequently developed the complications of rhabdomyolysis, acute kidney injury, pulmonary embolism, urinary retention and ileus. He received high-dose lorazepam, anticoagulation and intravenous fluids. Antipsychotic medication in the form of haloperidol was reinstated with no adverse effect, and he went on to make a full recovery. Conclusions: This case illustrates the potential life-threatening complications of neuroleptic malignant syndrome and the need for a low index of clinical suspicion. It also highlights the lack of evidence for treatment of catatonia, including the use of antipsychotics.

Atypical neuroleptic malignant syndrome and non-alcoholic Wernicke’s encephalopathy

2021 ◽  
Vol 14 (8) ◽  
pp. e244082
Author(s):  
Esther Shan Lin Hor ◽  
Gurpreet Pal Singh ◽  
Nurul Akhmar Omar ◽  
Vincent Russell
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Kidney Injury ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose ◽  
Fluphenazine Decanoate ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Atypical Presentations ◽  
High Index Of Suspicion

We report the case of a middle-aged woman with a history of bipolar disorder, in the absence of alcohol or substance misuse. The patient had been maintained on fluphenazine decanoate depot and now presented acutely with cognitive dysfunction and rigidity. Laboratory tests revealed elevated creatine kinase, acute kidney injury with metabolic acidosis and transaminitis, leading to a provisional diagnosis of neuroleptic malignant syndrome (NMS). Neuroleptics were withheld; dialysis was commenced; and blood biochemistry parameters improved in tandem. However, mental status changes persisted, and re-evaluation revealed multidirectional nystagmus with bilateral past-pointing. MRI confirmed the diagnosis of Wernicke’s encephalopathy (WE). Prompt recovery followed treatment with high-dose intravenous thiamine. We discuss the co-occurrence of NMS and non-alcoholic WE—highlighting the need for a high index of suspicion for these relatively rare neuropsychiatric diagnoses which are often missed in those with atypical presentations.

Neuroleptic malignant syndrome: Case report and literature review

2017 ◽  
Vol 41 (S1) ◽  
pp. S564-S564
Author(s):  
R. Martín Gutierrez ◽  
R. Medina Blanco ◽  
P. Suarez Pinilla ◽  
R. Landera Rodriguez ◽  
M. Juncal Ruiz ◽  
...  
Keyword(s):  
Literature Review ◽  
Neuroleptic Malignant Syndrome ◽  
Life Support ◽  
Clinical Symptoms ◽  
Altered Mental Status ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Neuroleptic Treatment ◽  
Pubmed Database ◽  
Competing Interest

IntroductionNeuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.ObjectiveTo review the incidence, clinical characteristics, diagnosis and treatment of NMS.AimWe have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.MethodsA literature review of the NMS was performed using the PubMed database.ResultsThe frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.ConclusionsNMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Successful clozapine rechallenge following clozapine-induced neuroleptic malignant syndrome

2015 ◽  
Vol 5 (2) ◽  
pp. 88-90 ◽  
Author(s):  
Clint Ross
Keyword(s):  
Adverse Effect ◽  
Neuroleptic Malignant Syndrome ◽  
Mental Status ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Treatment Resistant ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Potential Risks

Abstract Neuroleptic malignant syndrome (NMS) is a potential life-threatening adverse effect of antipsychotics. Characteristic signs and symptoms of NMS include hyperthermia, muscle rigidity, altered mental status, and autonomic instability. Treatment of NMS includes discontinuation of any antipsychotic or other potentially offending agents. This report describes the details of a patient diagnosed with NMS induced by clozapine with subsequent successful rechallenge. Given limited therapeutic options for patients with treatment-resistant schizophrenia, clinicians should be cognizant of potential risks but aware of the possibility of successful rechallenge with clozapine.

scholarly journals TANGO-2 with Severe and Prolonged Rhabdomyolysis in a 2-year Old Male with Human metapneumovirus Infection. A case report and literature review.

2020 ◽  
Vol 7 ◽  
pp. 24-27
Author(s):  
Rowida Kheireldin ◽  
Sameer Imdad ◽  
Waseem Ostwani
Keyword(s):  
Case Report ◽  
Kidney Injury ◽  
Human Metapneumovirus ◽  
Creatinine Kinase ◽  
Intravenous Fluids ◽  
Unique Case ◽  
Inpatient Hospitalization ◽  
Aggressive Management ◽  
Acute Rhabdomyolysis ◽  
Life Threatening

We report a unique case of prolonged acute rhabdomyolysis in a 2-year-old male with known TANGO-2 mutation with delayed peak in creatinine kinase levels secondary to human metapneumovirus infection. Creatinine kinase peaked at 424,760 U/l on day 9 of hospitalization. Resolution of rhabdomyolysis was achieved using aggressive management with intravenous fluids with optimal urine output and no kidney injury.  TANGO-2 patients may develop severe and prolonged rhabdomyolysis with a delayed peak suggesting the need for prolonged inpatient hospitalization to prevent life-threatening complications.

scholarly journals Septic Pulmonary Embolism in an Intravenous Drug User

2010 ◽  
Vol 9 (1) ◽  
pp. 15-19
Author(s):  
Sarah Hoye ◽  
◽  
Damian Tolan ◽  
Aleck Brownjohn ◽  
◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Drug User ◽  
Intravenous Drug User ◽  
Clinical Suspicion ◽  
Intravenous Drug ◽  
Recent Case ◽  
Life Threatening ◽  
Septic Pulmonary Embolism ◽  
Delays In Diagnosis

A recent case of septic pulmonary embolism in an intravenous drug user, complicated by issues of recurrent self discharge and delays in diagnosis yields opportunity to increase awareness of this uncommon yet life-threatening disorder. The literature is reviewed and includes suggested aids to raise clinical suspicion and improve subsequent management.

scholarly journals Clinical and Demographic Predictors of Acute Pulmonary Embolism in Central Africa Using 64-Rows Multi-Detector Computed Tomography Angiography

2017 ◽  
Vol 2 (2) ◽  
pp. 185
Author(s):  
Florent Wetshokonda Lomamba ◽  
Jean Mukaya Tshibola ◽  
Michel Lelo Tshikwela
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Acute Pulmonary Embolism ◽  
Central Africa ◽  
Clinical Suspicion ◽  
Logistic Regression Models ◽  
Demographic Predictors ◽  
Life Threatening ◽  
Multi Detector Computed Tomography

<p><em>Background: Acute pulmonary embolism is a life-threatening entity. Its diagnosis remains a challenge for clinicians and it is important to be aware of factors that increase risks of the disease. In this study, we access the clinical and demographic predictors of pulmonary embolism using 64-rows multi-detector Computed Tomography Angiography in central Africa.</em></p><p><em>Methods: From 01 January to 30 July 2016, the data record of patients who underwent chest 64-rows multi-detector Computed Tomography Angiography indicated for clinical suspicion of acute pulmonary embolism at Biamba Marie Mutombo Dikembe Hospital were retrospectively </em><em>were revisited and analyzed using logistic regression models.</em><em></em></p><p><em>Results: Sixty-five consecutive patients (age range, 24 to 84 years and mean age 56.8 ± 14.9 years) were included with a female predominance. Pulmonary embolism was formerly detected in 17 patients (26.2% of cases). Age ≥ 65 years (OR = 9.5 CI 95%:14.74, 60.79, p = 0.018) and obesity (OR = 40.8 CI 95%:2.85, 58.44, p = 0.006) were the predictors of pulmonary embolism. Heart disease and pneumonia were the main pathologies associated and the main alternative diagnoses.</em></p><p><em>Conclusion: This study shows that age and obesity were independent predictors of PE. In central Africa</em><em> where Computed Tomography machine is not widely available,</em><em> aged and obese patients</em><em> with a clinical suspicion of pulmonary embolism</em><em> </em><em>should be dealt with as a higher suspicion of true </em><em>pulmonary embolis</em><em>m.</em><em> </em></p>

Acute kidney injury and nephrotic syndrome associated with eltrombopag therapy in chronic idiopathic thrombocytopenic purpura

2021 ◽  
Vol 14 (4) ◽  
pp. e241462
Author(s):  
Suchi Anindita Ghosh ◽  
Jean Patrick ◽  
Kyaw Zin Maw
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Nephrotic Syndrome ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Kidney Injury ◽  
High Dose ◽  
Chronic Idiopathic Thrombocytopenic Purpura ◽  
Thrombocytopenic Purpura ◽  
Antibody Screen ◽  
Auto Antibody

A 77-year-old man was admitted with severe acute kidney injury and nephrotic syndrome. He was started on eltrombopag for chronic idiopathic thrombocytopenic purpura 6 weeks earlier. An ultrasound of the kidneys was normal and an auto-antibody screen was negative. The use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient’s development of acute renal failure and eltrombopag therapy. Literature review identified only one other case of nephrotic syndrome and acute kidney injury associated with eltrombopag therapy in which a kidney biopsy revealed focal segmental glomerulosclerosis. Due to the challenges faced during the prevailing SARS-CoV-2 pandemic and persistent low platelet counts a renal biopsy was not undertaken. On stopping eltrombopag, the patients renal function stabilised and he successfully went into remission following treatment with high dose corticosteroids and diuretics. This report of a serious case of reversible renal failure and nephrotic syndrome after treatment with eltrombopag may serve to inform clinicians about the possible severe renal adverse effects of eltrombopag before its commencement for future use.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

scholarly journals Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis

2020 ◽  
Author(s):  
Fernando Scudiero ◽  
Antonino Pitì ◽  
Roberto Keim ◽  
Guido Parodi
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Retrospective Studies ◽  
Right Heart ◽  
Clinical Issue ◽  
Systemic Thrombolysis ◽  
Case Summary ◽  
High Prevalence ◽  
Life Threatening ◽  
Complex Scenario

Abstract Background Despite the fast-growing understanding of the coronavirus disease 2019 (COVID-19), patient management remains largely empirical or based on retrospective studies. In this complex scenario, an important clinical issue appears to be represented by the high prevalence of thromboembolic events, but the data regarding high-risk pulmonary embolism (PE) is still not available. Case summary A patient with COVID-19 developed sudden shortness of breath and hypoxia. Early echocardiographic diagnosis of high-risk PE related to right heart thrombus was performed. Systemic thrombolysis was administered with excellent clinical and haemodynamic response. Discussion Pulmonary thromboembolism is a common occurrence in severe COVID-19 infection. In our experience, systemic thrombolysis proved to be effective and for this reason may be considered for life-threatening PE in COVID-19 patients.

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