Síndrome neuroléptico maligno debido a ziprasidona: reporte de un caso

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Abstract

El síndrome neuroléptico maligno es una rara y potencialmente fatal reacción adversa medicamentosa, asociada usualmente al uso de antipsicóticos. Tiene por características la presencia de fiebre, rigidez muscular, estado mental alterado y disfunción autonómica. Los hallazgos de laboratorio son inespecíficos, sin embargo, la presencia de leucocitosis y elevación de la creatina fosfoquinasason hallazgos frecuentes. Presentamos el caso de un paciente varón de 51 años, natural de Lima con antecedentes médicos de tuberculosis pulmonar y esquizofrenia que acude a nuestro hospital con un cuadro de psicosis quien, luego de ser tratado con ziprasidona administrada por vía intramuscular, presentó los síntomas característicos de un síndrome neuroléptico maligno. Conocer la clínica y la fisiopatología de este síndrome nos permitirá un mejor abordaje, ya que por su poca frecuencia podría no llegar a plantearse dentro de los diagnósticos diferenciales, lo que resultaría perjudicial para el paciente.

Translated abstract

Neuroleptic malignant syndrome is a rare and potentially fatal drug adverse reaction, usually associated with antipsychotics. Signs and symptoms include: fever, muscle rigidity, altered mental status and autonomic dysfunction. Laboratory findings are nonspecific, however the presence of leukocytosis and elevated creatinine phosphokinase are frequent findings. We present the case of a 51-year-old male patient from Lima with a medical history of pulmonary tuberculosis and schizophrenia that comes to our hospital with psychotic symptoms. After being treated with ziprasidone, administered by intramuscular injection presents with typical symptoms of neuroleptic malignant syndrome. Knowing the clinical features and the pathophysiology of this syndrome will allow us to better approach the condition. Due to its infrequent presentation, it may not be considered within the differential diagnosis, which could be harmful to the patient.

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Most cited references 21

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Neuroleptic malignant syndrome.

J Strawn, Stanley N. Caroff, Benjamin P. Keck (2007)

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Neuroleptic malignant syndrome: a review for neurohospitalists.

Brian Berman (2011)

Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction. It has been associated with virtually all neuroleptics, including newer atypical antipsychotics, as well as a variety of other medications that affect central dopaminergic neurotransmission. Although uncommon, NMS remains a critical consideration in the differential diagnosis of patients presenting with fever and mental status changes because it requires prompt recognition to prevent significant morbidity and death. Treatment includes immediately stopping the offending agent and implementing supportive measures, as well as pharmacological interventions in more severe cases. Maintaining vigilant awareness of the clinical features of NMS to diagnose and treat the disorder early, however, remains the most important strategy by which physicians can keep mortality rates low and improve patient outcomes.

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Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

Martino Belvederi Murri, Argentina Guaglianone, Michele Bugliani … (2015)

Background Neuroleptic malignant syndrome (NMS) is a rare, severe, idiosyncratic adverse reaction to antipsychotics. Second-generation antipsychotics (SGAs) were originally assumed to be free from the risk of causing NMS, however several cases of NMS induced by SGAs (SGA-NMS) have been reported. Objectives The aim of this study was to systematically review available studies and case reports on SGA-NMS and compare the presentation of NMS induced by different SGAs. Data Sources Citations were retrieved from PubMed up to November 2013, and from reference lists of relevant citations. Study Eligibility Criteria Eligibility criteria included (a) primary studies reporting data on NMS, with at least 50 % of the sample receiving SGAs; or (b) case reports and case reviews reporting on NMS induced by SGA monotherapy, excluding those due to antipsychotic withdrawal. Study Appraisal and Synthesis Methods A standardized method for data extraction and coding was developed for the analysis of eligible case reports. Results Six primary studies and 186 individual cases of NMS induced by SGAs were included. Primary studies suggest that SGA-NMS is characterized by lower incidence, lower clinical severity, and less frequent lethal outcome than NMS induced by first-generation antipsychotics. Systematic analysis of case reports suggests that even the most recently marketed antipsychotics are not free from the risk of inducing NMS. Furthermore, clozapine-, aripiprazole- and amisulpride-induced NMS can present with atypical features more frequently than other SGA-NMS, i.e. displaying less intense extrapyramidal symptoms or high fever. Limitations Case reports report non-systematic data, therefore analyses may be subject to bias. Conclusions and Implications of Key Findings Clinicians should be aware that NMS is virtually associated with all antipsychotics, including those most recently marketed. Although apparently less severe than NMS induced by older antipsychotics, SGA-NMS still represent a relevant clinical issue. Electronic supplementary material The online version of this article (doi:10.1007/s40268-014-0078-0) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (publisher-id): rnp

Title: Revista de Neuro-Psiquiatría

Abbreviated Title: Rev Neuropsiquiatr

Publisher: Universidad Peruana Cayetano Heredia. Facultad de Medicina (Lima, , Peru )

ISSN (Print): 0034-8597

Publication date (Print and electronic): October 2019

Volume: 82

Issue: 4

Pages: 298-303

Affiliations

[01] Lima orgnameUniversidad de San Martín de Porres orgdiv1Facultad de Medicina orgdiv2Centro de Investigación en Salud Pública Perú

[02] Lima orgnameUniversidad Nacional Mayor de San Marcos orgdiv1Facultad de Medicina de San Fernando orgdiv2Departamento Académico de Psiquiatría Perú

[03] Lima orgnameEsSalud orgdiv1Hospital Nacional Guillermo Almenara Irigoyen orgdiv2Departamento de Psiquiatría Perú

Article

Publisher ID: S0034-85972019000400009 Publisher ID: S0034-8597(19)08200400009

DOI: 10.20453/rnp.v82i4.3652

SO-VID: 587423d9-c833-4097-8c62-9f6ced507e80

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 16 November 2019

Date accepted : 19 December 2019

Page count

Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 6

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SciELO Peru

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