Neuroleptic malignant syndrome presenting as pulmonary edema and severe bronchorrhea.
Neuroleptic malignant syndrome is a rare (incidence, 0.02%-3.2%) but dangerous complication following the use of neuroleptic drugs. When not promptly recognized, this disease carries a high mortality (10%-20%) and morbidity rate. We report an unusual case of neuroleptic malignant syndrome that presented predominantly with autonomic instability in the form of recurrent episodes of respiratory distress. The respiratory distress was initially caused by pulmonary edema and later was caused by severe bronchorrhea. We propose that aspiration pneumonia resulting in respiratory failure, the leading cause of death in neuroleptic malignant syndrome, may be a result of a combination of altered mental status and bronchorrhea. This has therapeutic implications because early institution of bromocriptine/dantrolene can prevent aspiration pneumonia and, hence, mortality from respiratory failure.
Patel
U
U
Division of Cardiology, Coney Island Hospital, New York, New York 11235, USA.
Agrawal
M
M
Krishnan
P
P
Niranjan
S
S
D000547:Amantadine / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects; D001971:Bromocriptine / Q000627:therapeutic use; D003620:Dantrolene / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000150:complications* / Q000188:drug therapy; D011654:Pulmonary Edema / Q000209:etiology* / Q000517:prevention & control
D014150:Antipsychotic Agents; D018491:Dopamine Agonists; D018492:Dopamine Antagonists; D001971:Bromocriptine; D000547:Amantadine; D003620:Dantrolene