Neuroleptic Malignant Syndrome Associated with Rhabdomyolysis Induced by Antipsychotic Agents: A Rare Occurrence

Abstract

Neuroleptic Malignant Syndrome (NMS) is a medical emergency of infrequent presentation in Emergency department, which is associated with the use of psychotropic agents, classical and atypical antipsychotics. We report a case involving a 56-year-old male patient diagnosed with schizophrenia and depression for 30 years, who had been receiving Amisulpride, Trifluoperazine, Clozapine, and Amitryptiline as part of his treatment. This patient presented with symptoms of NMS with fever, muscle rigidity, altered mental state, elevated CPK, Urea, and S. Creatinine levels. NMS may be responsible for serious rhabdomyolysis, acute respiratory distress syndrome, and disseminated intravascular coagulation. We hypothesize the occurrence of acute renal failure precipitated by NMS. His treatment included the withdrawal of all psychotropic agents, Bromocriptine, and other supportive measures.

Atypical Antipsychotics and Lithium Induced Neuroleptic Malignant Syndrome associated with Acute Kidney Injury: A Case Report

“…Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal EPS occurring in individuals using antipsychotic medications, with an incidence ranging from 0.02 to 3%. 4 The prevailing theory suggests that the central blockade of dopamine D2 receptors is responsible for the development of rigidity and hyperthermia and other symptoms of NMS. 7 It is an idiosyncratic reaction that can manifest unpredictably.…”

“…2 Notably, malignant hyperthermia in NMS can induces rhabdomyolysis which is destruction of muscle fibres which can precipitate acute kidney injury due to myoglobin's nephrotoxic effects. 3,4 Use of Complex polypharmacy (CP), that includes using three or more medications concomitantly for treating bipolar disorder, has increased over time. 5 In this case report, we present case details of a patient having bipolar disorder under a regimen of Olanzapine, Clozapine, and Lithium carbonate, who developed NMS and acute kidney injury.…”