Key result
Treatment with biperiden, dopamine agonists, and muscle relaxants successfully resolved neuroleptic malignant syndrome in a 21-year-old man following haloperidol and risperidone exposure.
Why the study?
Neuroleptic malignant syndrome is an uncommon but critical differential diagnosis for fever and mental status changes requiring prompt resuscitation, with few reported cases of antipsychotic-induced presentations.
Case Report (n=1)
No
Prompt recognition and treatment of antipsychotic-induced neuroleptic malignant syndrome with muscle relaxants, dopamine agonists, and biperiden can lead to rapid clinical recovery.
Prompt NMS recognition is essential in febrile patients with mental status changes on antipsychotics; this case report leaves open atypical presentations in young adults.
Neuroleptic malignant syndrome (NMS) causes fever, muscle rigidity, and impaired mental status. Drugs that influence central dopaminergic neurotransmission and almost all neuroleptics, including newer atypical antipsychotics, are also associated with it. While uncommon, NMS remains a critical differential diagnosis for patients with fever and mental status changes due to the requirement for prompt resuscitation to prevent morbidity and mortality. We present a case of a 21-year-old man with schizophrenia who attended the emergency room with generalized muscle rigidity, high-grade fever, and disturbed mental status for 12 days. His serum creatine phosphokinase was elevated (CPK). The computed tomography (CT) of the brain was normal, and the CSF was clear and cell-free. The patient was given muscle relaxants, dopamine agonists, and biperiden. After three days, rigidity, fever, and consciousness improved. A few cases of antipsychotic-induced NMS have been reported. Healthcare professionals should be aware of this fatal side effect.
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Sidow et al. (2022) conducted a case report in Neuroleptic Malignant Syndrome (n=1). Biperiden, dopamine agonists, and muscle relaxants was evaluated on Symptom resolution. Treatment with biperiden, dopamine agonists, and muscle relaxants successfully resolved neuroleptic malignant syndrome in a 21-year-old man following haloperidol and risperidone exposure.
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