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Case Reports
. 2022 Sep 2;42(3):445-449.
doi: 10.7705/biomedica.6428.

Neuroleptic malignant syndrome associated with acute organophosphate poisoning: Case report

[Article in English, Spanish]
Nancy Y Angulo  1 , Paula A Castaño  2 , Crhistian C Gómez  3 , Santiago Quintero  3
Affiliations
Case Reports

Neuroleptic malignant syndrome associated with acute organophosphate poisoning: Case report

[Article in English, Spanish]
Nancy Y Angulo et al. Biomedica. .

Abstract
in English, Spanish

Neuroleptic malignant syndrome is a rare and potentially fatal clinical condition frequently associated with the use of antipsychotics. In the literature, there is only one case report associated with the intake of organophosphates. We present the case of a patient who presented with a clinical picture compatible with neuroleptic malignant syndrome, after the ingestion of an organophosphate (chlorpyrifos). A 57-year-old man who consulted for attempted suicide, acute deterioration of consciousness, torpid neurological evolution, and associated autonomic instability associated with rigidity, persistent hyperthermia, and elevated CPK. Bromocriptine treatment was offered, which resolved the clinical picture. The association with the ingestion of an organophosphate was established, and he was discharged without sequelae. The diagnosis of neuroleptic malignant syndrome is clinical and should be considered in any case of exposure to substances that may lead to dysregulation of dopaminergic neurotransmission in order to initiate timely therapy and impact outcomes.

El síndrome neuroléptico maligno es una condición clínica rara y potencialmente letal que frecuentemente se asocia con el uso de antipsicóticos. En la literatura especializada se encontró únicamente un reporte de caso relacionado con la ingestión de organofosforados. Se presenta un paciente con un cuadro clínico correspondiente al síndrome neuroléptico maligno posterior a la ingestión de clorpirifós. Como resultado de un intento de suicidio con el mencionado organofosforado, el hombre de 57 años presentó deterioro agudo del estado de consciencia, evolución neurológica tórpida e inestabilidad autonómica asociada a rigidez e hipertermia persistentes, así como incremento de la creatina-fosfocinasa (creatine phosphokinase, CPK). Se le administró tratamiento con bromocriptina, con lo cual el cuadro clínico remitió, y fue dado de alta sin secuelas. El diagnóstico del síndrome neuroléptico maligno es clínico y debe contemplarse en cualquier caso de exposición a sustancias que puedan resultar en una desregulación de la neurotransmisión dopaminérgica, con el fin de iniciar el tratamiento oportuno y contrarrestar efectivamente los efectos.

Keywords: Neuroleptic malignant syndrome; insecticides; organophosphate; cholinesterases; bromocriptine; fever; rhabdomyolysis.

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Conflict of interest statement

Conflicto de intereses: Los autores declaran no tener conflicto de intereses.

Figures

Figura 1
Figura 1. Relación de la evolución de los valores de la creatina fosfocinasa (creatine phosphokinase, CPK) (línea gris) y la temperatura en grados Celsius (línea negra)
See this image and copyright information in PMC

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