title: A Rare Case of Myxedema Coma with Neuroleptic Malignant Syndrome (NMS).
abstract: Myxedema coma or hypothyroid crisis is an endocrine emergency and needs ICU management. Neuroleptic malignant syndrome (NMS) is another medical emergency which needs high degree of clinical suspicion else mortality can be high. There is a paradox in co existence of myxedema coma and NMS. While one is hypometabolic state another is hypermetabolic state and both can be precipitated by antipsychotics use. Hypothermia and flaccidity commonly expected in myxedema coma may mask fever and rigidity of classical NMS contributing to diagnostic problem and treatment delay. Scientific literature on coexistance of myxedema coma and NMS is sparse. We hereby report first case with coexisting myxedema coma and NMS in a patient of schizophrenia treated with antipsychotic, where classical symptoms of NMS were masked by myxedema coma. Prompt diagnosis and effective management by a team resulted in favourable outcome in our patient. This case is reported to alert intensive care physicians to atypical manifestations of NMS in presence of hypothyroidism.
authors.affiliation: Classified Specialist Psychiatry, Department of Psychiatry, Base Hospital, Delhi Cantt, Assistant Professor, Department of Psychiatry, Army College of Medical Science , New Delhi, India .
authors.forename: Siddharth
authors.initials: S
authors.lastname: Dixit
authors.affiliation: Classified Specialist Endocrinology, Base Hospital Delhi Cantt. Assistant Professor, Army College of Medical Science , New Delhi, India .
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Dutta
authors.affiliation: DNB Resident, Department of Psychiatry, Base Hospital , Delhi Cantt, India .
authors.forename: Mayank
authors.initials: M
authors.lastname: Namdeo
keywords: Atypical antipsychotics; Atypical neuroleptic malignant syndrome; Hypothyroid crisis; Primary hypothyroidism