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

Öz

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.

Anahtar Kelimeler

• neuroleptic malignant syndrome
• cancer
• schizophenia

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

Öz

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.

Anahtar Kelimeler

• nöroleptik malign sendrom
• kanser
• şizofreni

Kaynakça

1. 1.Kawanishi C. Genetic predisposition to neuroleptic malignant syndrome: implications for antipsychotic therapy. American journal of pharmacogenomics: genomics-related research in drug development and clinical practice. 2003;3(2):89-95.
2. 2.Gurrera RJ. Sympathoadrenal hyperactivity and the etiology ofneuroleptic malignant syndrome. American Journal ofPsychiatry. 1999;156(2):169-80.
3. 3.Sato I, Onishi H, Kawanishi C, Yamada S, Ishida M, Kawakami K. Neuroleptic malignant syndrome in patients with cancer: a systematic review. BMJ Supportive & Palliative Care. 2020;10(3):265-70.
4. 4.Trollor JN, Chen X, Chitty K, Sachdev PS. Comparison ofneuroleptic malignant syndrome induced by first-and second-generation antipsychotics. The British Journal of Psychiatry.2012;201(1):52-6.
5. 5.BALTACIOĞLU M, Hocaoğlu Ç. Nöroleptik Malign Sendrom nedir? Tanı ve tedavi yaklaşımları. Journal of Contemporary Medicine. 2019;9(4):424-31.
6. 6.Kawanishi C, Onishi H, Kato D, Yamada T, Onose M,Hirayasu Y. Neuroleptic malignant syndrome in cancertreatment. Palliative & Supportive Care. 2005;3(1):51-3.
7. 7.Strawn JR, Keck Jr M, Paul E, Caroff SN. Neurolepticmalignant syndrome. American Journal of Psychiatry.2007;164(6):870-6.
8. 8.Wittmann O, Sadot E, Bisker-Kassif O, Scolnik D, Tavor O,Glatstein MM. Neuroleptic malignant syndrome associated with metoclopramide use in a boy: case report and review ofthe literature. American Journal of Therapeutics. 2016;23(5):e1246-e9.

9. 9.Kawanishi C. Genetic predisposition to neuroleptic malignant syndrome. American Journal of Pharmacogenomics. 2003;3(2):89-95.
10. 10.Akechi T, Uchitomi Y, Okamura H, Fukue M, Kagaya A,Nishida A, et al. Usage of haloperidol for delirium in cancer patients. Supportive care in cancer. 1996;4(5):390-2.
11. 11.Tanaka K, Akechi T, Yamazaki M, Hayashi R, Nishiwaki Y, Uchitomi Y. Neuroleptic malignant syndrome during haloperidol treatment in a cancer patient. Supportive care in cancer. 1998;6(6):536-8.
12. 12.Baykara M, Algin E, Büyükberber S, Tufan G, Cavnar B, Demirci U, et al. Metastatik Gastrik Karsinomlu Bir Olguda Metoklopropamid İlişkili Nöroleptik Malign Sendrom. GaziMedical Journal. 2013;24(2).
13. 13.Baba O, Yamagata K, Tomidokoro Y, Tamaoka A, Itoh H,Yanagawa T, et al. Neuroleptic malignant syndrome in a patient with tongue cancer: a report of a rare case. Case Reports inDentistry. 2013;2013.
14. 14.Öncü F, Hariri A, Ceylan ME. Nöroleptik malign sendrom. Düşünen Adam. 1998;11(4):30-5.
15. 15.Hodgson R, Wildgust HJ, Bushe CJ. Cancer and schizophrenia: is there a paradox? Journal of Psychopharmacology.2010;24(4_suppl):51-60.
16. 16.Chou FHC, Tsai KY, Wu HC, Shen SP. Cancer in patients withschizophrenia: What is the next step? Psychiatry and Clinical Neurosciences. 2016;70(11):473-88.
17. 17.Bushe CJ, Bradley AJ, Wildgust HJ, Hodgson RE. Schizophrenia and breast cancer incidence: a systematic review of clinical studies. Schizophrenia Research. 2009;114(1-3):6-16.