title: [Neuroleptic malignant syndrome : Rare cause of fever of unknown origin].
abstract: Neuroleptic malignant syndrome (NMS) is a possible cause of fever of unknown origin (FUO) and is a potentially fatal adverse effect of various drugs, especially of neuroleptics. First generation antipsychotics, such as received by the patient described in this article, are more likely to cause NMS than second generation antipsychotics. The key symptoms are the development of severe muscle rigidity and elevated temperature associated with the use of neuroleptic medication. Malignant catatonia (MC) is an important differential diagnosis of NMS. While neuroleptics can trigger NMS and must be immediately discontinued if NMS occurs, neuroleptic therapy represents the first line treatment for MC. This article describes the case of a patient with schizoaffective disorder where initially the diagnosis of NMS was not clear. Eventually, fever and a markedly elevated serum creatine kinase (CK) led to the correct diagnosis and the appropriate therapy with dantrolene, bromocriptine and amantadine. Furthermore, a thorough review of the currently available literature on NMS is provided.
authors.affiliation: Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke mit Sitz in Köln, Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland, ChackupurakalR@kliniken-koeln.de.
authors.forename: R
authors.initials: R
authors.lastname: Chackupurakal
authors.forename: U
authors.initials: U
authors.lastname: Wild
authors.forename: M
authors.initials: M
authors.lastname: Kamm
authors.forename: F
authors.initials: F
authors.lastname: Wappler
authors.forename: D
authors.initials: D
authors.lastname: Reske
authors.forename: S G
authors.initials: SG
authors.lastname: Sakka
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002389:Catatonia / Q000628:therapy; D003402:Creatine Kinase / Q000097:blood; D003937:Diagnosis, Differential; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents; D015415:Biomarkers; D003402:Creatine Kinase