Lethal neuroleptic malignant syndrome due to amisulpride

Abstract

A 42-year old-man was found lying in his bed having seizures. Later he became unconscious and hypotonic developing mydriasis as well as rigidity. The body core temperature (rectal temperature) was above 42 °C. Blood pH was decreased during treatment, and his general condition deteriorated. The patient developed gasping respiration, ventricular fibrillation, and died. During autopsy and histological investigation cerebral and pulmonary edema were noted together with general congestion of the internal organs. Further observations included contraction bands of myocytes, a contracted spleen, fibrosis of the liver, and gall stones. Toxicological analyses of peripheral blood revealed the following results: amisulpride 4.65 mg/l, biperiden 0.12 mg/l, imipramine 0.33 mg/l, and desipramine 0.68 mg/l. An amisulpride-induced neuroleptic malignant syndrome was therefore diagnosed as the patho-physiological mechanism leading to death.

An update of safety of clinically used atypical antipsychotics

“…A case report described a tardive oculogyric crisis [28]. A lethal MMS has been documented as well [29].…”

Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: Nuances and pragmatics of the association

“…Several cases of amisulpride-induced NMS have been described in the literature, 22 , 23 many reported in elderly males. The clinical profile primarily involves an altered mental state, frequent rigidity and high levels of CPK, whereas high fever, tremor and other autonomic symptoms have been reported less frequently.…”

Neuroleptic malignant syndrome associated with amisulpride and lithium: a case report

“…There were no cases of NMS associated with amisulpride reported in these two reviews [3,18]. However, we found six single case studies of NMS during amisulpride treatment described in the literature since 2004 [19][20][21]. In three of these cases the contribution of additional factors was present, i.e.…”

“…addition of oxcarbazepine to amisulpride, myopathy and chronic toxic encephalopathy [19,20]. In one of the cases lethal amisulpride-induced neuroleptic malignant syndrome was diagnosed at autopsy [21].…”