Neuroleptic malignant syndrome with clomipramine

Document Type : Case report

Authors

1 Department of internal medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Neuroleptic malignant syndrome (NMS) is a neurologic emergency condition that may arise as a result of the administration of potent psychotropic agents but it is not only antipsychotics alone that should be blamed for being behind the occurrence of this syndrome . This syndrome is characterized by fever and rigidity. Further symptoms include impaired consciousness, autonomic dysfunction, increased creatine kinase (CK), and leukocytosis. We report a case of a middle age woman with a past medical history of depression presented to the emergency room with alteration of mental status , neuromuscular hyper excitability, pyrexia, muscle rigidity and urinary incontinence following ingestion of clomipramine, a drug not noted for dopamine blockade. A firm diagnosis of NMS was made . After discontinue medication, therapy with Bromocriptine and Lorazepam was started. Within a few days, the patient improved significantly and CPK level returned to normal after 5 days.It is necessary to mention that the use of drugs other than antipsychotic agents can lead to NMS. Likely, the number of agents that can precipitate this syndrom will most probably increase by years.

Keywords

References

  1. Kuhlwilm L, Schönfeldt‐Lecuona C, Gahr M, Connemann B, Keller F, Sartorius A. The neuroleptic malignant syndrome—a systematic case series analysis focusing on therapy regimes and outcome. Acta Psychiatrica Scandinavica. 2020;142(3):233-41.
  2. Adnet P, Lestavel P, Krivosic‐Horber R. Neuroleptic malignant syndrome. British journal of anaesthesia. 2000;85(1):129-35.
  3. Velamoor VR. Neuroleptic malignant syndrome. Drug Safety. 1998;19(1):73-82.
  4. van Rensburg R, Decloedt EH. An Approach to the Pharmacotherapy of Neuroleptic Malignant Syndrome. Psychopharmacol Bull. 2019;49(1):84-91.
  5. Dosi R, Ambaliya A, Joshi H, Patell R. Serotonin syndrome versus neuroleptic malignant syndrome: a challenging clinical quandary. Case Reports. 2014;2014:bcr2014204154.
  6. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner Journal. 2013;13(4):533-40.
  7. Strawn JR, Keck Jr M, Paul E, Caroff SN. Neuroleptic malignant syndrome. American Journal of Psychiatry. 2007;164(6):870-6.
  8. Haddow AM, Harris D, Wilson M, Logie H. Clomipramine induced neuroleptic malignant syndrome and pyrexia of unknown origin. BMJ. 2004;329(7478):1333-5.
  9. Pileggi DJ, Cook AM. Neuroleptic malignant syndrome: focus on treatment and rechallenge. Annals of Pharmacotherapy. 2016;50(11):973-81.
  10. Oruch R, Pryme IF, Engelsen BA, Lund A. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatric disease and treatment. 2017;13:161.
medical journal of mashhad university of medical sciences
Volume 67, Issue 1
March and April 2024
Pages 67-71

Files

Share

How to cite

Statistics