Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
Am J Emerg Med. 2024 Jul;81:160.e1-160.e2. doi: 10.1016/j.ajem.2024.03.032. Epub 2024 Apr 2.
Neuroleptic malignant syndrome (NMS) is a rare yet severe condition typically associated with antipsychotic medications. Here, we present a case of NMS induced by prochlorperazine in a 76-year-old male with multiple comorbidities, aiming to delineate its clinical manifestation, diagnostic complexities, and treatment approaches. Our methodology involved a thorough documentation of the patient's medical history, initial symptoms, physical examination findings, laboratory results, diagnostic processes, and subsequent therapeutic interventions. The patient exhibited classic NMS symptoms, including fever, altered mental status, autonomic dysregulation, and generalized rigidity, consistent with diagnostic criteria. Notably, laboratory investigations failed to reveal the typical abnormalities often seen in NMS cases, highlighting the diverse presentation of this syndrome. Management strategies primarily focused on benzodiazepines and amantadine, leading to a gradual improvement in symptoms and eventual resolution of NMS. This underscores the critical role of early recognition and appropriate pharmacotherapy in managing prochlorperazine-induced NMS, even at standard dosage levels. The absence of characteristic laboratory findings in NMS poses challenges in diagnosis, necessitating a comprehensive clinical assessment for accurate identification. Moreover, this case emphasizes the need for further research to better understand the pathophysiology of prochlorperazine-induced NMS and optimize treatment protocols. In conclusion, our case report sheds light on the complexities surrounding NMS induced by prochlorperazine, emphasizing the importance of vigilant monitoring and tailored therapeutic strategies in mitigating its potentially life-threatening consequences.
神经阻滞剂恶性综合征(NMS)是一种罕见但严重的病症,通常与抗精神病药物有关。在这里,我们报告了一例由丙氯拉嗪引起的 NMS 病例,该病例涉及一位 76 岁的合并多种疾病的男性,旨在描述其临床表现、诊断复杂性和治疗方法。我们的方法包括详细记录患者的病史、初始症状、体格检查结果、实验室结果、诊断过程和随后的治疗干预措施。该患者表现出典型的 NMS 症状,包括发热、精神状态改变、自主神经失调和全身僵硬,符合诊断标准。值得注意的是,实验室检查未能显示出 NMS 病例中常见的典型异常,突出了该综合征的多种表现形式。管理策略主要集中在苯二氮䓬类药物和金刚烷胺上,导致症状逐渐改善,最终 NMS 得到缓解。这强调了在管理丙氯拉嗪引起的 NMS 时,早期识别和适当的药物治疗的关键作用,即使在标准剂量水平下也是如此。NMS 缺乏特征性的实验室发现给诊断带来了挑战,需要进行全面的临床评估以准确识别。此外,该病例强调了进一步研究的必要性,以更好地了解丙氯拉嗪引起的 NMS 的病理生理学,并优化治疗方案。总之,我们的病例报告揭示了丙氯拉嗪引起的 NMS 所涉及的复杂性,强调了 vigilant 监测和量身定制的治疗策略的重要性,以减轻其潜在的危及生命的后果。