[Successful treatment of levodopa-induced neuroleptic malignant syndrome (NMS) with disseminated intravascular coagulation (DIC) in a patient with Parkinson's disease]

Abstract

A 77-year-old woman with a 9 years history of Parkinson's disease was admitted to our hospital because of high fever, disturbance of consciousness, increased muscular rigidity and abnormal involuntary movements. She was continuously treated with levodopa + carbidopa (Menesit) 300 mg and amantadine 150 mg every day until admission. On admission, the pulse rate was 102 per minute, blood pressure 90/40 mmHg, body temperature 40.9 degrees C, and bloody stool was noticed. On laboratory examination, erythrocyte sedimentation rate was 6 mm/h, thrombocytes 8.1 X 10(4)/microliters, fibrinogen 91 mg/dl, FDP 40 mg/ml, suggesting DIC. According to her biochemical examination, serum GOT (167 u), GPT (119 u), CPK (847 IU/l), BUN (53.9 mg/dl) and myoglobin (10,370 ng/ml) were increased. These laboratory data indicated that she was suffering from neuroleptic malignant syndrome (NMS) with disseminated intravascular coagulation (DIC). On diagnosis of NMS associated with DIC, she was treated with dantrolene and FUT-175. Dantrolene was effective on the elevated COK level and FUT-175 was effective on the DIC, and symptoms of NMS and DIC were completely improved after a period of 14 days. Patients with Parkinson's disease have been suspected to have a low incidence of DIC, and this may be the first case report on successful treatment of levodopa-induced NMS with DIC in the patient with Parkinson's disease.