Uzun Salınımlı Enjekte Edilebilir Aripripazol Kullanımını Takiben Gecikmiş Ve Atipik Nöroleptik Malign Sendrom

Year 2025, Volume: 8 Issue: 1, 37 - 41, 29.03.2025

Serhat Bulut , Yusuf Kenan Özkan , Melis Efeoğlu Saçak , Mehmet Birkan Korgan , Sena Özge Aslan , Oğuzhan Demir , Erhan Altunbaş , Arzu Denizbaşı

https://doi.org/10.54996/anatolianjem.1552190

Abstract

Amaç: Nöroleptik malign sendrom (NMS), santral dopaminerjik yolaklar üzerine etkili antipsikotik ilaçlarla
ilişkili nadir görülen ancak yaşamı tehdit eden klinik bir durumdur. Genellikle haloperidol gibi yüksek etkili klasik antipsikotiklerle ilişkilendirilirken, aripiprazol gibi atipik antipsikotikler de NMS'ye neden olabilir. Sendrom, hipertermi, otonomik instabilite, değişen mental durum ve kas rijiditesi ile karakterizedir, ancak atipik vakalarda bu belirgin özelliklerden bazıları eksik olabilir. Uzun etkili enjektabl (USE) aripiprazol kullanımı sonrası gecikmiş atipik semptomlarla gelen bir NMS olgusunu sunmayı amaçladık.

Olgu Sunumu: Olgumuzda bipolar bozukluğu ve majör depresyonu olan ve uzun salınımlı enjektabl (USE)
aripiprazolden sonra atipik NMS gelişen 40 yaşında bir kadın vakasını sunuyoruz. Rijiditesi olmamasına rağmen, motor atımlar, otonomik instabilite ve kreatin kinaz seviyelerinde gecikmeli yükselme meydana gelen hastada NMS, diğer nedenler dışlandıktan sonra teşhis edildi, ancak hastanın kliniği hızla kötüleşti; akut böbrek yetmezliği, kardiyovasküler instabilite ve malign aritmi hastanın ölümüyle sonuçlandı.

Sonuç: Bu vaka, USE aripiprazol kullanımı ile NMS'nin gecikmiş ve atipik semptomlarla başvurma potansiyelini vurgulayarak, rijidite gibi tipik semptomlar olmasa bile klinisyenlerin NMS'ye karşı yüksek bir şüphe barındırmaları gerektiğinin altını çizmektedir.

Keywords

Nöroleptik malign sendrom, antipsikotikler, aripiprazol

Ethical Statement

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review in this journal.

Supporting Institution

Destekleyen kurum yoktur

Delayed and Atypical Neuroleptic Malignant Syndrome Following Extended-Release Injectable Aripiprazole Use

Abstract

Aim: Neuroleptic malignant syndrome (NMS) is an uncommon but life-threatening condition associated with antipsychotic medications that interfere with central dopaminergic pathways. While typically linked to highpotency antipsychotics like haloperidol, atypical antipsychotics such as aripiprazole can also induce NMS. The syndrome is characterized by hyperthermia, autonomic instability, altered mental status, and muscle rigidity, though atypical cases may lack some of these hallmark features. We aim to present an NMS case presented with delayed atypical symptoms following extended-release injectable (ERI) aripiprazole.

Case Presentation: A 40-year-old female patient with bipolar disorder and major depression arrived at the emergency department complaining of decreased mental clarity, difficulty with swallowing solid food, and impairments in communication and mobility who received ERI aripiprazole 40 days prior to admission. Despite lacking rigidity, she exhibited motor jerks, autonomic instability, and a delayed elevation in creatine kinase levels. NMS was diagnosed after excluding other causes, but the patient
deteriorated rapidly, developing acute renal failure, cardiovascular instability, and malignant arrhythmia, which led to death.

Conclusion: This case highlights the potential for delayed and atypical presentations of NMS with ERI aripiprazole, emphasizing the need for clinicians to maintain a high index of suspicion for NMS, even when typical symptoms like rigidity are absent.

Keywords

Neuroleptic malignant syndrome, antipsychotic agents, aripiprazole

Ethical Statement

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review in this journal.

Supporting Institution

There is no specific funding related to this case report.

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