Ecstacy-induced delayed rhabdomyolysis and neuroleptic malignant syndrome in a patient with a novel variant in the ryanodine receptor type 1 gene.
We present the case of a 20-year-old woman who developed rhabdomyolysis, disseminated intravascular coagulopathy and multi-organ failure induced by ecstasy. Following initial improvement, she developed delayed rhabdomyolysis then haloperidol-induced neuroleptic malignant syndrome, which was treated with a total of 50 mg.kg(-1) dantrolene. Subsequent genetic testing revealed a novel potentially pathogenic variant in the ryanodine receptor type 1 gene. However, caffeine-halothane contracture testing of the patient's mother who carried the same gene variant was negative for malignant hyperthermia.
Anaesthesia Department, Sir Charles Gairdner Hospital, Perth, Western Australia. twainrussell@gmail.com
T
T
Russell
S
S
Riazi
N
N
Kraeva
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AC
Steel
L A
LA
Hawryluck
D018685:Anesthetics, Inhalation; D014150:Antipsychotic Agents / Q000009:adverse effects; D001831:Body Temperature; D002110:Caffeine; D000697:Central Nervous System Stimulants; D002851:Chromatography, High Pressure Liquid; D003402:Creatine Kinase / Q000097:blood; D003620:Dantrolene / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D014644:Genetic Variation; D006213:Hallucinogens / Q000009:adverse effects*; D006220:Haloperidol / Q000009:adverse effects; D006221:Halothane; D006801:Humans; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000503:physiopathology; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D009459:Neuroleptic Malignant Syndrome / Q000235:genetics* / Q000503:physiopathology*; D012008:Recurrence; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000235:genetics / Q000503:physiopathology; D019837:Ryanodine Receptor Calcium Release Channel / Q000235:genetics*; D013057:Spectrum Analysis; D055815:Young Adult
D018685:Anesthetics, Inhalation; D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants; D006213:Hallucinogens; D019837:Ryanodine Receptor Calcium Release Channel; D002110:Caffeine; D003402:Creatine Kinase; D003620:Dantrolene; D006220:Haloperidol; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D006221:Halothane