Olanzapine-associated Neuroleptic Malignant Syndrome: A Case Report Olanzapine Bağlı Nöroleptik Malign Sendrom: Olgu sunumu

Year 2019, Volume: 7 Issue: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 564 - 567, 10.12.2019

Kezban Öztürk Abdullah Yazar , Abdullah Yazar , Semih Erden , Alper Yıldırım , Hüseyin Çaksen

Abstract

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially lethal drug reaction, most often seen as a complication of antipsychotic treatment. The most common clinical findings in NMS are; hyperthermia, extrapyramidal symptoms, high creatinine kinase (CK) levels, altered mental state and leukocytosis.

Case Report:
A 15-year-old male patient with the diagnosis of mucopolysaccharidosis type 3C and autism spectrum disorder from another center had been prescribed olanzapine 5 mg orally twice daily for psychotic disorder by a child psychiatrist ten days ago. On the seventh day, the mother stopped the drug completely because the patient had an inappetence, agitation, swallowing problem and developed severe muscle rigidity in the prostration position. On the tenth day, the patient was brought to our pediatric emergency department in the prostration position suffering from muscle rigidity in the whole body and was unable to move (Figure 1A). He was firstly administered biperiden as considering extrapyramidal side effect of olanzepine and than diagnosed with NMS after noticing fever. Subsequently dantrolene was administered intravenously at a dose of 2.5mg/kg in addition to the low-dose midazolam infusion. The patient could only received three doses of dantrolene due to lack of availability. On the second day, the treatment was continued with midazolam infusion and bromocriptine administered orally twice a day. He gradually improved over one week, and bromocriptine was tapered gradually but thereafter he developed ventilator-associated pneumonia and discharged in stable condition on day 30 (Figure 1B).

Conclusion:
Early diagnosis of NMS and cessation of the drug, prompt medical intervention are life saving. It is therefore essential for all physicians to become familiar with the diagnosis and treatment of this serious and treatable drug reaction. Our aim is to increase the awareness, and recognition of NMS for reducing its incidence and mortality.

Keywords

Neuroleptic malignant syndrome, olanzapine, bromocriptine

References

• References: 1. Modi S, Dharaiya D, Schultz L, Valeras P. Neuroleptic malignant syndrome: complications, outcomes, and mortality. Neurocrit Care 2016; 24:97-103. 2. Stubner S, Rustenbeck E, Grohmann R, et al. Severe and uncommon involuntary movement disorders due to psychotropic drugs. Pharmacopsychiatry 2004; 37:54-64. 3. Lejoyeux M, Fineyre F, Ades J. The serotonin syndrome. Am J Psychiatry 1992; 149: 1410-11. 4. Woo BK and Obrocea GV. Atypical case of neuroleptic malignant syndrome caused by olanzapine and carbamazepine. Psychiatry 2005; 2: 23-24. 5. Berman BD. Neuroleptic malignant syndrome: a review for neurohospitalists. Neurohospitalist 2011; 41–7. 6. Davis JM, Caroff SN, Mann SC. Treatment of neuroleptic malignant syndrome. Psychiatr Ann 2000; 30: 325–31.