title: Neuroleptic malignant syndrome masked by cerebral malaria.
abstract: A 38-year-old man with an underlying psychiatric illness presented with altered sensorium and abnormal behaviour. He was febrile at 38°C and weak looking; otherwise no other abnormalities were detected. A blood film conducted for malarial parasite (BFMP) revealed Plasmodium falciparum; hence a diagnosis of cerebral malaria was made. He was treated with antimalarial drugs for 2 days prior to being transferred out to the ward following clinical improvement. He subsequently developed episodes of stupor and refusal of feeding. Following an evaluation by the psychiatrist, a diagnosis of catatonic schizophrenia was made and he was started on oral sulpiride and benhexol. Unfortunately, he developed high-grade fever at 40°C with muscle rigidity and fasciculation. The diagnosis of neuroleptic malignant syndrome (NMS) was clinched and the antipsychotics were discontinued. However he succumbed to NMS several days later due to multiorgan failure.
authors.affiliation: Medicine Based Department, School of Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. farbe63@hotmail.com
authors.forename: Kumar Muniandy
authors.initials: KM
authors.lastname: Rajesh
authors.forename: Vellan
authors.initials: V
authors.lastname: Sinnathamby
authors.forename: Arul N
authors.initials: AN
authors.lastname: Sakthi
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D057210:Delayed Diagnosis; D017809:Fatal Outcome; D006801:Humans; D016779:Malaria, Cerebral / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000150:complications / Q000175:diagnosis*; D018377:Neurotransmitter Agents / Q000009:adverse effects* / Q000627:therapeutic use; D012560:Schizophrenia, Catatonic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D053608:Stupor / Q000175:diagnosis / Q000209:etiology; D013469:Sulpiride / Q000009:adverse effects / Q000627:therapeutic use; D014282:Trihexyphenidyl / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D018377:Neurotransmitter Agents; D014282:Trihexyphenidyl; D013469:Sulpiride