Gambassi Giovanni, Capurso Sabrina, Tarsitani Patrizia, Liperoti Rosa, Bernabei Roberto
Dipartimento di Scienze Gerontologiche, Centro di Medicina dell'Invecchiamento, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Aging Clin Exp Res. 2006 Jun;18(3):266-70. doi: 10.1007/BF03324659.
A 77-year-old patient with initial behavioral and psychological symptoms of dementia was treated with clozapine (50 mg/daily). Since no clinical benefit was apparent, clozapine was discontinued after six weeks and the patient started on paroxetine (20 mg/daily). After three weeks on paroxetine, he was given another trial of clozapine at a starting dosage of 25 mg/daily. While clozapine had previously been well tolerated, this time he rapidly developed fever, mental confusion, lethargy, muscle spasms and rigidity. The diagnosis of neuroleptic malignant syndrome was delayed, because there was no leukocytosis and serum creatine phosphokinase was initially not elevated. Subcutaneous apomorphine was then given but, after an initial improvement, the patient developed a multiple organ failure syndrome and died.
一名77岁患有初始痴呆行为和心理症状的患者接受了氯氮平治疗（50毫克/每日）。由于未观察到明显临床益处，六周后停用氯氮平，患者开始服用帕罗西汀（20毫克/每日）。服用帕罗西汀三周后，再次给予氯氮平试验性治疗，起始剂量为25毫克/每日。此前患者对氯氮平耐受性良好，但此次他迅速出现发热、精神错乱、嗜睡、肌肉痉挛和强直。由于没有白细胞增多且血清肌酸磷酸激酶最初未升高，神经阻滞剂恶性综合征的诊断被延误。随后给予皮下阿扑吗啡，但在最初症状改善后，患者出现多器官功能衰竭综合征并死亡。
