When the fever will not stop, stop the pills! A case report
ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laborator...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Associação Paulista de Medicina
2023-12-01
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| Series: | São Paulo Medical Journal |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802024000300700&lng=en&tlng=en |
| _version_ | 1827595501659226112 |
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| author | César Ricardo Coimbra de Matos Eduarda Maria da Conceição Sério Pereira Beirão Rafael Simões Neves António José Assunção Rui Moreira Marques |
| author_facet | César Ricardo Coimbra de Matos Eduarda Maria da Conceição Sério Pereira Beirão Rafael Simões Neves António José Assunção Rui Moreira Marques |
| author_sort | César Ricardo Coimbra de Matos |
| collection | DOAJ |
| description | ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome. |
| first_indexed | 2024-03-09T02:54:29Z |
| format | Article |
| id | doaj.art-d11cddca3a014663a5686c0207800141 |
| institution | Directory Open Access Journal |
| issn | 1806-9460 |
| language | English |
| last_indexed | 2024-03-09T02:54:29Z |
| publishDate | 2023-12-01 |
| publisher | Associação Paulista de Medicina |
| record_format | Article |
| series | São Paulo Medical Journal |
| spelling | doaj.art-d11cddca3a014663a5686c02078001412023-12-05T07:55:30ZengAssociação Paulista de MedicinaSão Paulo Medical Journal1806-94602023-12-01142310.1590/1516-3180.2022.0401.r1.13032023When the fever will not stop, stop the pills! A case reportCésar Ricardo Coimbra de Matoshttps://orcid.org/0000-0003-4539-9505Eduarda Maria da Conceição Sério Pereira Beirãohttps://orcid.org/0000-0002-8552-3710Rafael Simões Neveshttps://orcid.org/0000-0003-3010-5084António José Assunçãohttps://orcid.org/0000-0003-4727-5485Rui Moreira Marqueshttps://orcid.org/0000-0001-7012-3928ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802024000300700&lng=en&tlng=enNeuroleptic malignant syndromeAntipsychotic agentsFeverDrug-related side effects and adverse reactionsRisk factorsNeurolepticsAdverse drug reactionsAutonomic dysfunctionFactor, risk |
| spellingShingle | César Ricardo Coimbra de Matos Eduarda Maria da Conceição Sério Pereira Beirão Rafael Simões Neves António José Assunção Rui Moreira Marques When the fever will not stop, stop the pills! A case report São Paulo Medical Journal Neuroleptic malignant syndrome Antipsychotic agents Fever Drug-related side effects and adverse reactions Risk factors Neuroleptics Adverse drug reactions Autonomic dysfunction Factor, risk |
| title | When the fever will not stop, stop the pills! A case report |
| title_full | When the fever will not stop, stop the pills! A case report |
| title_fullStr | When the fever will not stop, stop the pills! A case report |
| title_full_unstemmed | When the fever will not stop, stop the pills! A case report |
| title_short | When the fever will not stop, stop the pills! A case report |
| title_sort | when the fever will not stop stop the pills a case report |
| topic | Neuroleptic malignant syndrome Antipsychotic agents Fever Drug-related side effects and adverse reactions Risk factors Neuroleptics Adverse drug reactions Autonomic dysfunction Factor, risk |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802024000300700&lng=en&tlng=en |
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