title: Lethal neuroleptic malignant syndrome due to amisulpride.
abstract: A 42-year old-man was found lying in his bed having seizures. Later he became unconscious and hypotonic developing mydriasis as well as rigidity. The body core temperature (rectal temperature) was above 42 °C. Blood pH was decreased during treatment, and his general condition deteriorated. The patient developed gasping respiration, ventricular fibrillation, and died. During autopsy and histological investigation cerebral and pulmonary edema were noted together with general congestion of the internal organs. Further observations included contraction bands of myocytes, a contracted spleen, fibrosis of the liver, and gall stones. Toxicological analyses of peripheral blood revealed the following results: amisulpride 4.65 mg/l, biperiden 0.12 mg/l, imipramine 0.33 mg/l, and desipramine 0.68 mg/l. An amisulpride-induced neuroleptic malignant syndrome was therefore diagnosed as the patho-physiological mechanism leading to death.
authors.affiliation: University Hospital, Institute of Forensic Medicine, Rheinische Friedrich-Wilhems-University Bonn, Stiftsplatz 12, 53111, Bonn, Germany. f.musshoff@uni-bonn.de
authors.forename: Frank
authors.initials: F
authors.lastname: Musshoff
authors.forename: Elke
authors.initials: E
authors.lastname: Doberentz
authors.forename: Burkhard
authors.initials: B
authors.lastname: Madea
mesh_terms: D000328:Adult; D000077582:Amisulpride; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000097:blood; D001344:Autopsy; D002423:Cause of Death; D017809:Fatal Outcome; D049429:Forensic Pathology / Q000379:methods; D053593:Forensic Toxicology / Q000379:methods; D006801:Humans; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D013469:Sulpiride / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D014150:Antipsychotic Agents; D013469:Sulpiride; D000077582:Amisulpride