Neuroleptic Malignant Syndrome Associated with Rhabdomyolysis Induced by Antipsychotic Agents: A Rare Occurrence



Abstract Views
573

Downloads
370

Citations

Share

##plugins.themes.bootstrap3.article.sidebar##

Submitted Aug 1, 2021
Published Aug 30, 2021
10.24018/clinicmed.2021.2.4.117

Abstract viewed = 573 times

Table of Contents

##plugins.themes.bootstrap3.article.main##

Neuroleptic Malignant Syndrome (NMS) is a medical emergency of infrequent presentation in Emergency department, which is associated with the use of psychotropic agents, classical and atypical antipsychotics. We report a case involving a 56-year-old male patient diagnosed with schizophrenia and depression for 30 years, who had been receiving Amisulpride, Trifluoperazine, Clozapine, and Amitryptiline as part of his treatment. This patient presented with symptoms of NMS with fever, muscle rigidity, altered mental state, elevated CPK, Urea, and S. Creatinine levels. NMS may be responsible for serious rhabdomyolysis, acute respiratory distress syndrome, and disseminated intravascular coagulation. We hypothesize the occurrence of acute renal failure precipitated by NMS. His treatment included the withdrawal of all psychotropic agents, Bromocriptine, and other supportive measures.

Keywords: Elevated CPK, Neuroleptic Malignant Syndrome (NMS), Rhabdomyolysis, Trifluoperazine

References

  1. P. D. Rogers, D. J. Krysan, “Antifungal Agents. In: Brunton LB, Lazo JS, Parker KL, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 13th ed. New York, NY: McGraw-Hill; 2018.
     Google Scholar
  2. J. R. Carbone, “The neuroleptic malignant and serotonin syndromes,” Emergency Medicine Clinics of North America, 18:2, pp. 317–325, 2000.
     Google Scholar
  3. S. N. Caroff, S. C. Mann, “Neuroleptic malignant syndrome,” Psychopharmacology Bulletin, 24:1, pp. 25–29, 1988.
     Google Scholar
  4. M. C. Tu, C. C. Hsiao, “Amisulpride and neuroleptic malignant syndrome.” Chang Gung Med J, 34:5, pp. 536-40, 2011.
     Google Scholar
  5. N. Kruijt, L. R. van den Bersselaar, J. Wijma, W. Verbeeck, M. J. Coenen, J. Neville, M. Snoeck, E. J. Kamsteeg, H. Jungbluth, C. Kramers, N. C. Voermans, “HyperCKemia and rhabdomyolysis in the neuroleptic malignant and serotonin syndromes: A literature review,” Neuromuscular Disorders, 2020.
     Google Scholar
  6. Z. Korzets, E. Zelter, J. Bernheim, “Acute renal failure in the setting of the neuroleptic malignant syndrome,” Nephrol Dial Transplant, 11:5 pp. 885-6, 1996.
     Google Scholar
  7. R. J. Gurrera, S. N. Caroff, A. Cohen et al., “An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method,” The Journal of Clinical Psychiatry, 72:9, pp. 1222–1228, 2011.
     Google Scholar
  8. E. G. Bywaters, D. Beall, “Crush Injuries with Impairment of Renal Function,” Br Med J, 22;1(4185):427-32, 1941.
     Google Scholar
  9. J. L. Karagianis, L. C. Phillips, K. P. Hogan, K. K. LeDrew, “Clozapine-associated neuroleptic malignant syndrome: two new cases and a review of the literature,” Annals of Pharmacotherapy, 33(5):623-30, 1999.
     Google Scholar
  10. J. R. Strawn, J. R. Keck, M. D. PE, S. N. Caroff, “Neuroleptic malignant syndrome,” American Journal of Psychiatry, 164(6):870-6, 2007.
     Google Scholar
  11. P. A. Torres, J. A. Helmstetter, A. M. Kaye, A. D. Kaye, “Rhabdomyolysis: pathogenesis, diagnosis, and treatment,” Ochsner J, 15(1):58-69, 2015.
     Google Scholar