Fulminant Neuroleptic Malignant Syndrome Induced by Low Doses of Quetiapine in an old Patient

Year 2016, Volume: 2 Issue: 1, 17 - 20, 27.04.2016

Tuba Özcan Nilay Taş Esra Demir Murat İşcanlı Özlem Özdemir Osman Bektaş Arzu Yıldırım

https://doi.org/10.19127/mbsjohs.12845

Abstract

Neuroleptic malignant syndrome (NMS), a rare but life-threatening idiosyncratic adverse reaction to antipsychotic medication. NMS is commonly seen with typical antipsychotics that also reported with atypical antipsychotic drugs. A 81-year-old man was presented to emergency department of our hospital due to altered mental state. He had been taking quetiapine for 3 days for management of aggressive behavior. Just after treatment with 50 mg/day quetiapine at the previous hospital, he developed hyperthermia, altered mental status and akineticrigid Parkinsonism, and he had been transferred to our hospital. He was diagnosed with possible NMS based on history, altered mental state, rigidity, leukocytosis, hyperthermia, and increased blood level of CK. So, he was admitted to the intensive care unit immediately. This paper reports a rare fulminant NMS induced by low doses of quetiapine. The clinical manifestations and laboratory test results corresponded to the diagnostic criteria of NMS. It must be kept in mind that even low doses of atypic antipsychotic drugs such as quetiapine can trigger NMS.

Keywords

neuroleptic malignant syndrome, atypical antipsychotic, quetiapine

References

• Adnet P, Lestavel P, Krivosic-Horber R. Neuroleptic malignant syndrome. Br J Anaesth 2000; 85: 129-35.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association 1994.
• Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. Neuroleptic malignant syndrome and atypical antipsychotic drugs. J of Clin Psychiatry 2004; 65: 464–70.
• Caroff SN, Stephan CM, Lazarus A, Sullivan K, MacFadden W, Neuroleptic malignant syndrome: diagnostic issues. Psychiatric Annals 1991; 21: 130–47.
• Caroff SN, Mann SC: Neuroleptic malignant syndrome. Medical Clinics of North America 1993; 77: 185–202.
• Chopra MP, Prakash SS, Raguram R. The neuroleptic malignant syndrome: an Indian experience. Compr Psychiatry 1999; 40: 19-23.
• Delay J, Pichot P, Lemperiere T, Elissalde B, Peigne F. A non-phenothiazine and non-reserpine major neuroleptic, haloperidol, in the treatment of psychosis. Ann Med Psychol (Paris).1960; 118: 145-52.
• Detweiler MB, Sullivan K, Sharma TR, Kim KY, Detweiler JG. Case Reports of Neuroleptic Malignant Syndrome in Context of Quetiapine Use. Psychiatr Q 2013; 84(4): 523-41.
• Kobayashi A, Kawanishi C, Matsumura T, Kato D, Furukawa R, Kishida I, et al. Quetiapine-induced neuroleptic malignant syndrome in dementia with Lewy bodies: A case report. Prog Neuro-Psychopharmacology Biol Psychiatry 2006; 30: 1170-2.
• Mann SC, Caroff SN, Lazarus A. Pathogenesis of neuroleptic malignant syndrome. Psychiatr Ann 1991; 21: 175-80.
• McEwan B. Allostasis and allostatic load. Implication for neuropsychopharmacology. Neuropsychopharmacology 2000; 22: 108-24.
• Nielsen RE, Jensen SOW, Nielsen J. Neuroleptic malignant syndrome-an 11-year longitudinal case-control study. Can J Psychiatry 2012; 57: 512–18.
• Strawn JR, Keck Jr PE, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164: 870-6.
• Trollor JN, Chen X, Sachdev PS. Neuroleptic malignant syndrome associated with atypical antipsychotic drugs. CNS Drugs 2009; 23: 477-92.
• Woods G, et al. Neuroleptic malignant syndrome associated with quetiapine and venlafaxine use: a case report and discussion. Ther Adv Psychopharmacol 2013; 3(1): 53-5.
• Zou D, Shao Y, Qin Z, Zhang J, Liu N, Li Z, et al. Death due to fulminant neuroleptic malignant syndrome induced by low doses of haloperidol: A rare case. Journal of Forensic and Legal Medicine 2014; 24: 12-14.