Fever, confusion, acute kidney injury: is this atypical neuroleptic malignant syndrome following polypharmacy with clozapine and risperidone?

作者：Cherry Scott; Siskind Dan; Spivak Valeria^*; Wysoczanski Daniel; Halangoda Priyangika

来源：Australasian Psychiatry, 2016, 24(6): 602-603.

DOI：10.1177/1039856216649768

• atypical
• clozapine
• neuroleptic malignant syndrome

Objective: Clozapine is the gold-standard antipsychotic medication for treatment-refractory schizophrenia (TRS). However, one potentially lethal side effect of clozapine, as with other antipsychotics, is neuroleptic malignant syndrome (NMS) which could present differently in clozapine therapy. 'Atypical NMS' is a recognised variant of NMS with less rigidity and delayed elevation of creatine kinase; this variant is associated with clozapine.
Method: A case from the author's clinical practice was reviewed.
Results: A 67-year-old man with TRS was treated with clozapine. Unfortunately, his physical condition deteriorated and he presented with atypical NMS, which initially was treated as presumable urinary tract infection.
Conclusions: Atypical NMS is associated with clozapine. This case exposes the potential difficulties in diagnosis, and highlights the importance of considering less common diagnoses in acutely unwell psychiatric patients.

• 出版日期2016-12