Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jan 23;2(1):e75.
doi: 10.1002/pcn5.75. eCollection 2023 Mar.

A fatal case of fulminant neuroleptic malignant syndrome: A case report

Hitomi Komoriya  1 , Konoka Nomura  1 , Toshinori Shirata  1 , Tadahiro Kobayashi  2 , Masaki Nakane  2 , Keisuke Noto  1 , Ryota Kobayashi  1 , Akihito Suzuki  1
Affiliations
Case Reports

A fatal case of fulminant neuroleptic malignant syndrome: A case report

Hitomi Komoriya et al. PCN Rep. .

Abstract

Background: Neuroleptic malignant syndrome (NMS), a rare but potentially life-threatening adverse reaction to treatment with antipsychotic drugs, is characterized by hyperthermia, muscle rigidity, impaired consciousness, and autonomic disturbances. Some reports have described rapidly progressing cases of NMS resulting in death within several days. This report describes a clinical course of fatal and fulminant NMS in a patient with schizoaffective disorder.

Case presentation: A 67-year-old man had long been in a stable condition under antipsychotic pharmacotherapy. At 3 days before admission to our hospital, he complained of diarrhea, fatigue, and reduced appetite. On admission to our hospital, he showed fever, mild muscle rigidity at the four extremities, elevated heart rate, hypertension, excessive diaphoresis, and decreased percutaneous oxygen saturation (SpO2). He was diagnosed as having NMS. Within 3 days after the onset of NMS, he displayed severe hyperthermia up to 41.4°C and severe autonomic disturbances, including elevated heart rate and hypertension. Despite treatments with dantrolene and bromocriptine, he went into shock and died on the fourth day after admission.

Conclusion: The present case suggests that severe hyperthermia and severe autonomic disturbances at the early stage of the onset might be signs of fatal and fulminant NMS. It may be recommended that clinicians consider electro-convulsive therapy when treating fulminant NMS with these symptoms.

Keywords: fatal and fulminant case; neuroleptic malignant syndrome; schizoaffective disorder; severe autonomic disturbances; severe hyperthermia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Caroff SN, Mann SC, Lazarus A, Sullivan K, MacFadden W. Neuroleptic malignant syndrome: diagnostic issues. Psychiatr Ann. 1991;21:130–47.
    1. Kuhlwilm L, Schönfeldt‐Lecuona C, Gahr M, Connemann BJ, Keller F, Sartorius A. The neuroleptic malignant syndrome – a systematic case series analysis focusing on therapy regimes and outcome. Acta Psychiatr Scand. 2020;142:233–41. - PubMed
    1. Guinart D, Misawa F, Rubio JM, Pereira J, Filippis R, Gastaldon C, et al. A systematic review and pooled, patient‐level analysis of predictors of mortality in neuroleptic malignant syndrome. Acta Psychiatr Scand. 2021;144:329–41. - PubMed
    1. Lenler‐Petersen P, Hansen BD, Hasselstrøm L. A rapidly progressing lethal case of neuroleptic malignant syndrome. Intensive Care Med. 1990;16:267–8. - PubMed
    1. Teo SK, Lam KN, Chew WL. A fulminant case of neuroleptic malignant syndrome. Singapore Med J. 1994;35:110–1. - PubMed

Publication types