Ilchef R
Hornsby Ku-ring-gai Mental Health Service, New South Wales, Australia.
Aust N Z J Psychiatry. 1997 Dec;31(6):877-9. doi: 10.3109/00048679709065516.
A case report of neuroleptic-induced laryngeal dystonia mimicking acute anaphylaxis is presented with a review of the literature and discussion of common diagnostic difficulties.
The patient was a 24-year-old man with recently diagnosed schizophrenia who presented twice to a general hospital with difficulty speaking within 72 hours of increasing his dose of haloperidol. On both occasions, he was treated aggressively for presumed anaphylaxis with adrenaline, antihistamines and high dose corticosteroids.
The symptoms resolved with supportive medical care, withdrawal of the haloperidol and substitution of risperidone. There was no evidence of hypersensitivity on subsequent skin testing with haloperidol.
This case illustrates one of the many clinical presentations of neuroleptic-induced dystonia. While suspected anaphylaxis needs to be vigorously treated, a history of neuroleptic use and particularly of a recent dosage increase should alert clinicians to the possibility of acute laryngeal dystonia.
本文报告一例抗精神病药物所致喉肌张力障碍酷似急性过敏反应的病例，并对相关文献进行回顾，讨论常见的诊断难点。
患者为一名24岁男性，近期诊断为精神分裂症，在增加氟哌啶醇剂量后72小时内两次因言语困难前往综合医院就诊。两次就诊时，均因疑似过敏反应而给予肾上腺素、抗组胺药和大剂量皮质类固醇进行积极治疗。
通过支持性医疗护理、停用氟哌啶醇并换用利培酮，症状得以缓解。后续用氟哌啶醇进行皮肤试验，未发现过敏迹象。
该病例说明了抗精神病药物所致肌张力障碍的众多临床表现之一。虽然疑似过敏反应需要积极治疗，但抗精神病药物使用史，尤其是近期剂量增加史，应提醒临床医生警惕急性喉肌张力障碍的可能性。
