Escobar-Vidarte Maria Fernanda, Loaiza-Osorio Sara, Messa Adriana A, Macías Gloria Elena
a University of Health Sciences , Universidad ICESI , Valle del Cauca , Colombia.
b Obstetric Intensive Care Unit , Fundación Valle del Lili , Valle del Cauca , Colombia.
J Matern Fetal Neonatal Med. 2019 Jul;32(14):2438-2441. doi: 10.1080/14767058.2018.1432591. Epub 2018 Feb 5.
Neuroleptic malignant syndrome (NMS) is a serious complication associated with the use of drugs that affect dopaminergic system neurotransmission. The occurrence of NMS during pregnancy or gestation is considered a life-threatening obstetric emergency.
We are reporting the first case in Latin America of NMS in one pregnant women with acute psychotic episode. One day after starting with antipsychotic therapy, she developed a fever higher than 39.0 °C with tachycardia, tachypnea, generalized muscle rigidity and somnolence, with creatine kinase (CPK) levels evidencing a result of 2800 U/L. She was treated successfully with levetiracetam, biperiden and quetiapine.
A search in PubMed, Embase and Ovid from 1988 to 2016 resulted in seven cases reported in either pregnant or puerperal women. In general, NMS resolves within 3-14 days; most NMS cases reported during pregnancy have involved the use of haloperidol (5 case reports) which is concordant with this report. The obstetric results were good in cases reported, only two women showed signs, among them: hyperemesis gravidarum and preterm delivery. Most of the pregnant women who had NMS presented other associated comorbidities, being mostly of infectious origin. In other investigations, it has been affirmed that NMS can become lethal in adults; however, in our search for pregnant women with this disease, no associated mortality was found.
NMS is seen infrequently during pregnancy. The clinical diagnosis requires high suspicion by the examiner. It is important that obstetricians timely recognize the condition.
神经阻滞剂恶性综合征（NMS）是一种与使用影响多巴胺能系统神经传递的药物相关的严重并发症。孕期或妊娠期发生NMS被视为危及生命的产科急症。
我们报告拉丁美洲首例患有急性精神病发作的孕妇发生NMS的病例。在开始抗精神病药物治疗一天后，她出现体温高于39.0°C，伴有心动过速、呼吸急促、全身肌肉僵硬和嗜睡，肌酸激酶（CPK）水平达2800 U/L。她接受左乙拉西坦、安坦和喹硫平治疗后康复。
检索1988年至2016年期间的PubMed、Embase和Ovid数据库，发现有7例报道的孕妇或产后妇女发生NMS的病例。一般来说，NMS在3 - 14天内缓解；孕期报道的大多数NMS病例都使用了氟哌啶醇（5例报告），本病例与之相符。报道病例的产科结局良好，只有两名女性出现了一些症状，其中包括妊娠剧吐和早产。大多数发生NMS的孕妇还伴有其他合并症，大多为感染性病因。在其他研究中，已证实NMS在成人中可能致命；然而，在我们检索的患有这种疾病的孕妇中，未发现相关死亡病例。
孕期NMS罕见。临床诊断需要检查者高度怀疑。产科医生及时识别该病症很重要。
