Neuroleptic Malignant Syndrome and Severe Thrombocytopenia: Case Report and Literature Review

Abstract

We report an unusual case of thrombocytopenia associated with neuroleptic malignant syndrome (NMS). A 31-year-old Black male with a history of hypertension, partial seizures, and schizophrenia developed acute rigidity closely followed by severe hyperpyrexia (temperature 102ЊF), tachypnea, and tachycardia. His home medications at the time of presentation included propanolol 10 mg tid, haloperidol 10 mg bid, sodium valproate 500 mg bid, benztropine 1 mg bid, and haloperidol decanoate 100 mg i.m. every 3 weeks, from another psychiatric facility. Despite vigorous therapy for the hyperthermia, he rapidly developed significant hypoxia requiring mechanical ventilation. A diagnosis of neuroleptic malignant syndrome was made and the patient continued to receive aggressive supportive care. On hospital day 2 his platelet count dropped to 47,000/Ȑl and bottomed out at 36,000/Ȑl by day 3 with other blood cell counts remaining within normal limits. Over the next few days he showed rapid clinical improvement with normalization of his blood chemistries and he was discharged home after 5 days of hospitalization in good condition.

Neuroleptic malignant syndrome: a fatal case with unusual features

“…Similar cases have been reported previously in the literature and this lack of rigidity stands out as an important factor which warrants further evaluation (6,7). Similarly thrombocytopaenia has also been observed in some case studies (8,9). The initial differential diagnosis of sepsis induced shock was ruled out due to negative blood and urine cultures, D dimers and reactive blood picture without evidence of sepsis.…”

Neuroleptic malignant-like syndrome causing thrombocytopaenia: a rare association

“…Brain CT or MRI and lumbar puncture may be required to exclude alternate diagnosis 12. Leucocytosis is the only frequent abnormality in haemogram although rarely thrombocytopaenia has been reported with NMS 7 8. However, thrombocytopaenia has yet not been reported with NM-like syndrome.…”

“…These may be complicated by acute renal failure, aspiration pneumonia, deep vein thrombosis and disseminated intravenous coagulation 5 6. Thrombocytopaenia in absence of disseminated intravascular coagulation has rarely been reported with NMS,7 8 but its association with NM-like syndrome has not been reported. Here, we present a case of Parkinson’s disease with NM-like syndrome associated with thrombocytopaenia along with type 1 respiratory failure and also narrate the likely pathophysiological mechanism.…”

L’hypothermie aux neuroleptiques, une complication méconnue : à propos d’un nouveau cas et revue de la base de la pharmacovigilance française

“…On notait aussi la présence d'une pathologie psychiatrique sous-jacente et l'association aux benzodiazépines, rapportées comme favorisant la survenue d'hypothermie aux neuroleptiques [8] ainsi que d'autres manifestations associées évocatrices d'effets indésirables attribuables aux neuroleptiques (bradycardie, troubles de la vigilance, syndrome extrapyramidal, thrombopénie [9]). Les posologies utilisées étaient adaptées au poids de la patiente.…”