Yamawaki Y, Ogawa N
Department of Neurological Medicine, Onomichi Municipal Hospital.
Rinsho Shinkeigaku. 1991 Jan;31(1):62-7.
A 77-year-old woman with a 9 years history of Parkinson's disease was admitted to our hospital because of high fever, disturbance of consciousness, increased muscular rigidity and abnormal involuntary movements. She was continuously treated with levodopa + carbidopa (Menesit) 300 mg and amantadine 150 mg every day until admission. On admission, the pulse rate was 102 per minute, blood pressure 90/40 mmHg, body temperature 40.9 degrees C, and bloody stool was noticed. On laboratory examination, erythrocyte sedimentation rate was 6 mm/h, thrombocytes 8.1 X 10(4)/microliters, fibrinogen 91 mg/dl, FDP 40 mg/ml, suggesting DIC. According to her biochemical examination, serum GOT (167 u), GPT (119 u), CPK (847 IU/l), BUN (53.9 mg/dl) and myoglobin (10,370 ng/ml) were increased. These laboratory data indicated that she was suffering from neuroleptic malignant syndrome (NMS) with disseminated intravascular coagulation (DIC). On diagnosis of NMS associated with DIC, she was treated with dantrolene and FUT-175. Dantrolene was effective on the elevated COK level and FUT-175 was effective on the DIC, and symptoms of NMS and DIC were completely improved after a period of 14 days. Patients with Parkinson's disease have been suspected to have a low incidence of DIC, and this may be the first case report on successful treatment of levodopa-induced NMS with DIC in the patient with Parkinson's disease.
一名患有9年帕金森病病史的77岁女性因高热、意识障碍、肌肉强直加重及异常不自主运动入院。入院前她持续每日服用左旋多巴+卡比多巴（美多芭）300毫克及金刚烷胺150毫克。入院时，脉搏率为每分钟102次，血压90/40毫米汞柱，体温40.9摄氏度，且发现有血便。实验室检查显示，红细胞沉降率为6毫米/小时，血小板8.1×10⁴/微升，纤维蛋白原91毫克/分升，纤维蛋白降解产物40毫克/毫升，提示弥散性血管内凝血（DIC）。根据其生化检查，血清谷草转氨酶（167单位）、谷丙转氨酶（119单位）、肌酸磷酸激酶（847国际单位/升）、尿素氮（53.9毫克/分升）及肌红蛋白（10370纳克/毫升）均升高。这些实验室数据表明她患有伴有弥散性血管内凝血（DIC）的抗精神病药恶性综合征（NMS）。在诊断为与DIC相关的NMS后，她接受了丹曲林和FUT - 175治疗。丹曲林对升高的肌酸磷酸激酶水平有效，FUT - 175对DIC有效，14天后NMS和DIC的症状完全改善。帕金森病患者一直被怀疑发生DIC 的发生率较低，这可能是首例关于成功治疗帕金森病患者左旋多巴诱发的NMS合并DIC的病例报告。
