A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy
Background and Objective: Methadone is an opioid agonist used for the treatment of addiction to opioid drugs. Toxic leukoencephalopathy can cause serious problem and even be life-threatening. Methadone-induced leukoencephalopathy is a rare condition of this toxicity. Because of the importance of thi...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Babol University of Medical Sciences
2022-03-01
|
| Series: | Majallah-i Dānishgāh-i ̒Ulūm-i Pizishkī-i Bābul |
| Subjects: | |
| Online Access: | http://jbums.org/article-1-10686-en.html |
| _version_ | 1828177988523393024 |
|---|---|
| author | MJ Nasr AH Zohrevand D Hosseini Talari A Alizadeh Khatir |
| author_facet | MJ Nasr AH Zohrevand D Hosseini Talari A Alizadeh Khatir |
| author_sort | MJ Nasr |
| collection | DOAJ |
| description | Background and Objective: Methadone is an opioid agonist used for the treatment of addiction to opioid drugs. Toxic leukoencephalopathy can cause serious problem and even be life-threatening. Methadone-induced leukoencephalopathy is a rare condition of this toxicity. Because of the importance of this situation and its treatment, we aim to report a case who is diagnosed as Methadone-induced leukoencephalopathy.
Case Report: A 63-year-old man referred with non-persistent fever, drowsiness, rigidity and suspected of neuroleptic malignant syndrome (NMS). He was addicted to opioid from young age. He was on maintenance therapy with 80 mg methadone syrup from 2 months ago. After the appearance of symptoms including delirium, impaired attention and consciousness, treatment was performed with half a tablet of haloperidol 0.5 mg twice a day before rigidity and fever. Multiple lesions were seen in baseline CT-Scan and MRI. Toxic laboratory examination showed methadone was positive and other toxins and opioids were negative. After two weeks, second MRI showed rapid progressive lesions in white matter. Thus, it was diagnosed as Methadone-induced leukoencephalopathy in addition to NMS. Hydration, bromocriptine tablets 2.5 mg twice a day, methadone tapering and haloperidol discontinuation were performed. After two months, the patient's consciousness was better and his CPK and LDH tests were normal.
Conclusion: Methadone-induced leukoencephalopathy is a very rare condition, but it is important for physicians to consider this diagnosis in patients using methadone, especially when they show neurological and psychiatric signs and symptoms. That’s because early methadone tapering can reduce and stop toxicity on the white matter of the brain. |
| first_indexed | 2024-04-12T05:08:31Z |
| format | Article |
| id | doaj.art-8223d8fef0984efd9e48b4bee001f57c |
| institution | Directory Open Access Journal |
| issn | 1561-4107 2251-7170 |
| language | English |
| last_indexed | 2024-04-12T05:08:31Z |
| publishDate | 2022-03-01 |
| publisher | Babol University of Medical Sciences |
| record_format | Article |
| series | Majallah-i Dānishgāh-i ̒Ulūm-i Pizishkī-i Bābul |
| spelling | doaj.art-8223d8fef0984efd9e48b4bee001f57c2022-12-22T03:46:50ZengBabol University of Medical SciencesMajallah-i Dānishgāh-i ̒Ulūm-i Pizishkī-i Bābul1561-41072251-71702022-03-01241423427A Case Report of Neuroleptic Malignant Syndrome during Methadone TherapyMJ Nasr0AH Zohrevand1D Hosseini Talari2A Alizadeh Khatir3 1. Student Research Committee, Babol University of Medical Sciences, Babol, I.R.Iran. 2.Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, I.R.Iran. 3.Department of Psychiatry, School of Medicine, Babol University of Medical Sciences, Babol, I.R.Iran. 4.Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran. Background and Objective: Methadone is an opioid agonist used for the treatment of addiction to opioid drugs. Toxic leukoencephalopathy can cause serious problem and even be life-threatening. Methadone-induced leukoencephalopathy is a rare condition of this toxicity. Because of the importance of this situation and its treatment, we aim to report a case who is diagnosed as Methadone-induced leukoencephalopathy. Case Report: A 63-year-old man referred with non-persistent fever, drowsiness, rigidity and suspected of neuroleptic malignant syndrome (NMS). He was addicted to opioid from young age. He was on maintenance therapy with 80 mg methadone syrup from 2 months ago. After the appearance of symptoms including delirium, impaired attention and consciousness, treatment was performed with half a tablet of haloperidol 0.5 mg twice a day before rigidity and fever. Multiple lesions were seen in baseline CT-Scan and MRI. Toxic laboratory examination showed methadone was positive and other toxins and opioids were negative. After two weeks, second MRI showed rapid progressive lesions in white matter. Thus, it was diagnosed as Methadone-induced leukoencephalopathy in addition to NMS. Hydration, bromocriptine tablets 2.5 mg twice a day, methadone tapering and haloperidol discontinuation were performed. After two months, the patient's consciousness was better and his CPK and LDH tests were normal. Conclusion: Methadone-induced leukoencephalopathy is a very rare condition, but it is important for physicians to consider this diagnosis in patients using methadone, especially when they show neurological and psychiatric signs and symptoms. That’s because early methadone tapering can reduce and stop toxicity on the white matter of the brain.http://jbums.org/article-1-10686-en.htmlmethadoneleukoencephalopathyneuroleptic malignant syndrome. |
| spellingShingle | MJ Nasr AH Zohrevand D Hosseini Talari A Alizadeh Khatir A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy Majallah-i Dānishgāh-i ̒Ulūm-i Pizishkī-i Bābul methadone leukoencephalopathy neuroleptic malignant syndrome. |
| title | A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy |
| title_full | A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy |
| title_fullStr | A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy |
| title_full_unstemmed | A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy |
| title_short | A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy |
| title_sort | case report of neuroleptic malignant syndrome during methadone therapy |
| topic | methadone leukoencephalopathy neuroleptic malignant syndrome. |
| url | http://jbums.org/article-1-10686-en.html |
| work_keys_str_mv | AT mjnasr acasereportofneurolepticmalignantsyndromeduringmethadonetherapy AT ahzohrevand acasereportofneurolepticmalignantsyndromeduringmethadonetherapy AT dhosseinitalari acasereportofneurolepticmalignantsyndromeduringmethadonetherapy AT aalizadehkhatir acasereportofneurolepticmalignantsyndromeduringmethadonetherapy AT mjnasr casereportofneurolepticmalignantsyndromeduringmethadonetherapy AT ahzohrevand casereportofneurolepticmalignantsyndromeduringmethadonetherapy AT dhosseinitalari casereportofneurolepticmalignantsyndromeduringmethadonetherapy AT aalizadehkhatir casereportofneurolepticmalignantsyndromeduringmethadonetherapy |