Neuroleptic Malignant Syndrome Developed in a Case with Invasive Ductal Carcinoma of the Breast Diagnosed with Schizophrenia

Abstract

Neuroleptic malignant syndrome (NMS) is a rare but mortal syndrome characterized by hyperthermia, muscular rigidity, altered consciousness, autonomic dysfunction, elevated serum creatine phosphokinase (CPK) level and leukocytosis. Fatigue, dehydration, and malnutrition are considered risk factors for NMS, and cancer patients represent a high-risk group for NMS. In this article, the detection of high fever, muscular rigidity, autonomic instability, high CPK and C-reactive protein (CRP) levels, and leukocytosis two days after haloperidol 5 mg/day intramuscular administration to control psychotic agitation in a 73-year-old patient with schizophrenia suggested NMS. The biopsy result of the patient with suspected metastatic hemorrhage in the brain computed tomography (CT) during follow-up was reported as invasive ductal carcinoma of the breast. When the literature is examined, our case is the first case of NMS developed as a result of antipsychotic use in a schizophrenic patient with breast cancer.

Keywords

• neuroleptic malignant syndrome
• cancer
• schizophenia

Memenin İnvaziv Duktal Karsinomu Tanısı Olan Şizofreni Olgusunda Gelişen Nöroleptik Malign Sendrom

Abstract

Nöroleptik malign sendrom (NMS) hipertermi, müsküler rijidite, bilinç değişikliği, otonomik disfonksiyon, serum kreatin fosfokinaz (CPK) düzeyinde yükselme ve lökositoz ile karakterize olan, nadir görülen ancak mortal seyreden bir sendromdur. Yorgunluk, dehidrasyon ve yetersiz beslenme NMS için risk faktörleri olarak kabul edilir ve kanser hastaları NMS için yüksek risk grubunu temsil etmektedir. Bu yazıda yetmiş üç yaşında şizofreni tanısıyla takipli bir hastada psikotik ajitasyonu kontrol altına almak amacıyla haloperidol 5 mg/gün intramüsküler olarak uygulanmasından iki gün sonra gelişen yüksek ateş, müsküler rijidite, otonomik instabilite gelişmesi, CPK ve C-reaktif protein (CRP) düzeyinde yükselme, lökositoz saptanması NMS düşündürmüştür. Takip sırasında istenen beyin bilgisayarlı tomografisinde (BT) metastatik kanamadan şüphelenilen hastanın, biyopsi sonucu memenin invaziv duktal karsinomu olarak raporlanmıştır. Literatür incelendiğinde olgumuz, meme kanseri olan şizofreni hastasında antipsikotik kullanımı sonucu gelişen ilk NMS olgusudur.

Keywords

• nöroleptik malign sendrom
• kanser
• şizofreni

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