scholarly journals Neuroleptic Malignant Syndrome-an uncommon complication of a common drug- a case report

Biomedicine ◽  
2021 ◽  
Vol 40 (4) ◽  
pp. 554-556
Author(s):  
Vaishnavi Danasekaran ◽  
S. Lokesh ◽  
Prasanna Venkatesh ◽  
Aftab .
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Unknown Origin ◽  
Nigrostriatal Pathway ◽  
Fatal Complication ◽  
Idiosyncratic Reaction ◽  
Pyrexia Of Unknown Origin ◽  
Common Drug ◽  
Drug History ◽  
Life Threatening ◽  
History Of

Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic reaction to neuroleptics and rarely to antidopaminergics. Although the incidence in India is 0.14%, it is potentially a fatal complication. NMS occurs due to a blockade in the dopamine receptor and nigrostriatal pathway. The following report is about our patient who was diagnosed with NMS. This patient was diagnosed of NMS due to a progressive rise in CPK NAC and liver enzymes, metabolic acidosis and pyrexia of unknown origin not responding to treatment. No foci for the cause of pyrexia were ascertained. However, a positive drug history of recent administration of Inj. Metaclopramide was the present treatment in the form of supportive care, by controlling rigidity, hyperthermia and preventing complications that can occur following the affliction of this condition. NMS is a potentially reversible fatal complication with a mortality rate of 30%. Indiscriminate usage of neuroleptics and antidopaminergics can inadvertently lead to patients developing this condition. This case has been reported to create awareness amongst physicians about this complication.

Risperidone-Induced Neuroleptic Malignant Syndrome: A Case Report and Review

1996 ◽  
Vol 41 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Gb Meterissian
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Features ◽  
Prior History ◽  
Extrapyramidal Side Effects ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication ◽  
The One

Objectives: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) — a rare but potentially life-threatening complication of neuroleptic therapy — 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. Methods: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. Results: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. Conclusions: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.

scholarly journals Granulomatosis with Polyangiitis Presenting as Pyrexia of Unknown Origin, Leukocytosis, and Microangiopathic Haemolytic Anemia

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Sima Terebelo ◽  
Iona Chen
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Immunosuppressive Treatment ◽  
Kidney Injury ◽  
Unknown Origin ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
High Dose ◽  
Normal Range ◽  
Pyrexia Of Unknown Origin ◽  
History Of ◽  
Haemolytic Anemia

A 66-year-old woman presented to the Emergency Department with a florid sepsis-like picture, a two-week history of fever, relative hypotension with end organ ischemia (unexplained liver enzyme and troponin elevations), and nonspecific constitutional symptoms. She was initially found to have a urinary tract infection but, despite appropriate treatment, her fever persisted and her white blood cell count continued to rise. During her hospitalization the patient manifested leukocytosis to 47,000 WBC/μL, ESR 67 mm/hr (normal range 0–42 mm/hr), CRP 17.5 mg/dL (normal range 0.02–1.20 mg/dL), and microangiopathic haemolytic anemia, with declining haemoglobin and haematocrit. An infectious aetiology was not found despite extensive bacteriologic studies and radiographic imaging. The patient progressed to acute kidney injury with “active” urinary sediment and proteinuria. Kidney biopsy results and serological titres of myeloperoxidase positive perinuclear-antineutrophil cytoplasmic antibodies (MPO+ p-ANCA) led to a diagnosis of granulomatosis with polyangiitis. Immunosuppressive treatment with high dose methylprednisolone and rituximab led to resolution of the leukocytosis and return of the haemoglobin and haematocrit values toward normal without further signs of hemolysis.

scholarly journals Metoclopramide-Induced Neuroleptic Malignant Syndrome: A Review Study

2020 ◽  
Vol 14 (3) ◽  
Author(s):  
Ideh Ghafour ◽  
Forouzan Elyasi
Keyword(s):  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Psychiatric Symptoms ◽  
Previous History ◽  
Muscle Rigidity ◽  
Drug Induced ◽  
Idiosyncratic Reaction ◽  
History Of ◽  
And Gender ◽  
Age Range

Context: Neuroleptic malignant syndrome (NMS) has been introduced as a rare but lethal and idiosyncratic reaction to neuroleptics/antipsychotics. The most obvious risk of this syndrome is the use of neuroleptics, especially high-potency ones. Metoclopramide is also known as an anti-nausea medication administered before surgery to manage digestive problems. Evidence Acquisition: Formerly, it had been assumed that metoclopramide was a type of chlorobenzamide that was not in the phenothiazine group but free of extrapyramidal side effects (EPSs). The sequential reports of complications indicate that metoclopramide can cause EPSs and drug-induced motor side effects. A total number of 5044 articles were obtained after the initial search. Then, two researchers independently screened out their titles, and abstracts and 20 articles were finally selected based on the inclusion criteria. Results: Of the 20 articles reporting metoclopramide-induced NMS, treatments had been successful in 16 (80%) cases, but it had led to death in four (20%) patients. There were 11 and 8 male and female patients, respectively, and gender was not mentioned for a patient in one article. The age range of the patients was from six months to 84 years, and the mean age was 50.92 years. Conclusions: Although NMS following metoclopramide intake is reported very rarely, it should be considered for any psychiatric symptoms with unexpected mental changes, muscle rigidity, and fever after being treated with metoclopramide. The neuroleptic malignant syndrome can occur following multiple doses or just one dose of metoclopramide. Also, metoclopramide use in patients affected with kidney failure is accompanied by a higher risk of NMS. A previous history of NMS, a recent episode of catatonia, and severe agitation are all taken into account as risk factors in this domain.

Malignant catatonia and neuroleptic malignant syndrome: How different/similar are they?

2016 ◽  
Vol 33 (S1) ◽  
pp. S640-S640 ◽  
Author(s):  
P. Sales ◽  
M. Bernardo ◽  
A. Lopes ◽  
E. Trigo
Keyword(s):  
Supportive Care ◽  
Neuroleptic Malignant Syndrome ◽  
Specific Treatment ◽  
Hemodynamic Instability ◽  
Psychotic Symptoms ◽  
Muscle Rigidity ◽  
Life Threatening ◽  
History Of ◽  
Competing Interest ◽  
Malignant Catatonia

IntroductionCatatonia is a neuropsychiatric syndrome that appears in medical, neurological or psychiatric conditions. There are presentation variants: “malignant catatonia” (MC) subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), possibly reflecting common pathophysiology.Objectives/methodsWe present a clinical vignette and review the literature available on online databases about MC/NMS.ResultsWe present a man, 41-years-old, black ethnicity, with no relevant medical history. He had two previous episodes compatible with brief psychosis, the last one in 2013, and a history of adverse reactions to low doses of antipsychotics. Since the last episode he was asymptomatic on olanzapine 2.5 mg id. He acutely presented to the Emergency Room with mutism, negativism, immobility and delusional speech, similar to the previous episodes mentioned and was admitted to a psychiatric infirmary, where his clinical condition worsened, showing muscle rigidity, hemodynamic instability, leukocytosis, rhabdomyolysis and fever. Supportive care was provided, olanzapine was suspended and electroconvulsive therapy (ECT) was initiated. After two months, he was discharged with no psychotic symptoms. He is still under ECT and no antipsychotic medication was reintroduced.Discussion/conclusionMany studies suggest that clinical or laboratory tests do not distinguish MC from NMS and that they are the same entity. These two conditions are life-threatening and key to treatment is a high suspicion level. There is no specific treatment; supportive care and stopping involved medications are the most widely used measures. ECT is a useful alternative to medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Neuroleptic malignant syndrome: case report

2021 ◽  
Vol 11 (1) ◽  
pp. 70
Author(s):  
Murshid C. P. ◽  
Bande Shareef ◽  
Parlapalli Hema
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Case Report ◽  
Respiratory Failure ◽  
Trigeminal Neuralgia ◽  
Neuroleptic Malignant Syndrome ◽  
Antipsychotic Drugs ◽  
Life Threatening ◽  
History Of ◽  
Neurologic Emergency

Neuroleptic malignant syndrome (NMS) is an infrequent, but potentially life-threatening neurologic emergency associated with the use of neuroleptic or antipsychotic drugs. A 43 years old male with a history of trigeminal neuralgia developed Neuroleptic malignant syndrome while receiving Carbamazepine and Amitryptylline. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. Complications of NMS include acute renal failure and acute respiratory failure. The possible etiologies, triggering factors and treatment are discussed with reference to existing literature.

scholarly journals Clomipramine induced neuroleptic malignant syndrome and pyrexia of unknown origin

BMJ ◽  
2004 ◽  
Vol 329 (7478) ◽  
pp. 1333-1335 ◽  
Author(s):  
Alison M Haddow ◽  
Dawn Harris ◽  
Martin Wilson ◽  
Hannah Logie
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Unknown Origin ◽  
Pyrexia Of Unknown Origin

scholarly journals Acute bilateral myopia induced by Triplixam: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ruta Jaruseviciene ◽  
Ginte Sirvydyte
Keyword(s):  
Adverse Effect ◽  
Ciliary Body ◽  
Volume Effect ◽  
Systemic Hypertension ◽  
Blurred Vision ◽  
Idiosyncratic Reaction ◽  
Case Presentation ◽  
Common Drug ◽  
History Of ◽  
Choroidal Effusion

Abstract Background Side effects of the systemic drugs used to treat eyes are not common. Triplixam is used to treat systemic hypertension and contains amlodipine, indapamide and perindopril arginine as active ingredients which might have induced the sudden myopia. The transient myopia with objective findings disappeared after the discontinuation of the drug. Case presentation A 33-year-old male presented to the emergency department with a history of blurred vision in both eyes. Development of myopia, lens thickening, choroidal effusion and retinal striae at the macula with the increase in macular thickness was observed in both eyes. These symptoms cleared completely after the drug was discontinued. Myopisation could have been caused by lens thickening and changing its refractive index as a result of allergic or idiosyncratic reaction of the ciliary body. Retinal striae may be caused by the volume effect of the choroidal effusion. Conclusion Our report describes the adverse effect of Triplixam, probably resulting from its ingredient indapamide. Although indapamide is a common drug used in the treatment of systemic hypertension, it is important for cardiologists, general practitioners and other physicians to be aware of the possible adverse effect of Triplixam.

Hyperthermia and neuroleptic malignant syndrome-Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s829-s830
Author(s):  
K. Puljić ◽  
M. Herceg ◽  
V. Jukić
Keyword(s):  
Malignant Hyperthermia ◽  
Neuroleptic Malignant Syndrome ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Idiosyncratic Reaction ◽  
Malignant Neuroleptic Syndrome ◽  
Neuroleptic Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Competing Interest

Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases. Malignant hyperthermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to certain drugs. The 46-years-old female patient was diagnosed schizophrenia at the age of 22. Currently, she is hospitalized due to psychotic decompensation. The patient was admitted with following daily dose therapy of: haloperidol 15 mg, biperiden 4 mg and diazepam 15 mg. During this hospitalization she developes muscle rigidity, tremor, hyperthermia, and laboratory results showed increase of enzimes CPK and LDH, so we started treatment of suspected malignant neuroleptic syndrome. After a treatment and recovery with complete withdrawal of all presented symptoms, our patient developed a malignant hypertermia that was resistant to all applicated medications. Our dilemma is whether presented symptoms of malignant hyperthermia are related to malignant neuroleptic syndrome or not?Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Successful Medical Management of a Retroperitoneal Abscess: A Difficult Diagnosis in Pyrexia of Unknown Origin

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
U. G. H. Ishan ◽  
M. C. K. Thilakasiri ◽  
P. N. Weeratunga ◽  
R. D. Lanerolle
Keyword(s):  
Medical Management ◽  
Unknown Origin ◽  
Definitive Treatment ◽  
Retroperitoneal Abscess ◽  
Delay In Diagnosis ◽  
Pyrexia Of Unknown Origin ◽  
Patient Reported ◽  
History Of ◽  
The Right ◽  
Tract Infections

Retroperitoneal abscesses are uncommon conditions with occult and insidious presentations. There is often a lack of abdominal signs and ultrasound findings, causing a delay in diagnosis and definitive treatment, leading to poor patient outcomes. We report a case of right-sided retroperitoneal abscess of a 28-year-old female patient with diabetes mellitus. Prior to admission, the patient reported a vague 2 weeks history of right-sided back and abdominal pain and dysuria. She presented to our medical ward with suspected pyelonephritis with right-sided renal abscess. A retroperitoneal abscess involving the right renal fossa was revealed on an urgent CT scan. The patient underwent percutaneous ultrasound-guided pigtail catheter drainage. Patient clinically and biochemically improved with medical management gradually over 2 weeks. This case report highlights the importance of investigating for recurrent urinary tract infections of diabetics which are often overlooked in general practice.

scholarly journals Side effects of antipsychotic agents: Neuroleptic malignant syndrome

2010 ◽  
Vol 63 (9-10) ◽  
pp. 705-708 ◽  
Author(s):  
Mina Cvjetkovic-Bosnjak ◽  
Branislava Soldatovic-Stajic
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotics ◽  
Signs And Symptoms ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Symptomatic Therapy ◽  
Idiosyncratic Reaction ◽  
Hypothalamic Nuclei ◽  
Life Threatening ◽  
Possible Cause

Neuroleptic malignant syndrome is a rare, potentially life-threatening complication which is an unpredictable, idiosyncratic reaction to antipsychotics. In patients receiving traditional antipsychotics, neuroleptic malignant syndrome occurs with an incidence of 0.2-3.3%. However, neuroleptic malignant syndrome also appears in patients treated with atypical antipsychotics, especially Clozapine. A possible cause of neuroleptic malignant syndrome is blockade of dopamine receptors in the nigrostriatal tracts or hypothalamic nuclei. If signs and symptoms of the Neuroleptic malignant syndrome are identified in time, full recovery is possible. This is a report of a female patient with neuroleptic malignant syndrome treated by traditional antipsychotics. As soon as neuroleptic malignant syndrome symptoms were recognized, the antipsychotic drugs were discontinued, symptomatic therapy was initiated and symptoms of neuroleptic malignant syndrome disappeared. However, the patient's psychotic symptoms persisted and an atypical antipsychotic was administered. During the next few days the psychotic symptoms gradually disappeared and the patient accomplished good recovery.

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