Atypical Neuroleptic Malignant Syndrome: Pitfalls and Challenges in the Delirious Substance Abuser

Nirav N. Shah, Kristin G. Fless, Mikhail Litinski, Fariborz Rezai, Paul C. Yodice, Henry Rosenberg

Department of Medical Education and Clinical Research, St. Barnabas Medical Center, Livingston, USA.
Department of Surgery and Critical Care Medicine, St. Barnabas Medical Center, Livingston, USA.

DOI: 10.4236/ojanes.2012.22013                

Abstract

Introduction: A rare and atypical form of Neuroleptic Malignant Syndrome (NMS) can be a deceptive and life threatening condition if not diagnosed properly in acute and critical care settings. Methods: The management of a patient presenting with atypical NMS without prominent rigidity, but with extensive rhabdomyolysis after the administration of haloperidol and ziprasidone is described in this report. Results: Prompt recognition of atypical features of NMS was managed by intensive care unit admission, supportive care and pharmacotherapy, leading to a complete resolution of the syndrome and a favorable outcome verified by laboratory findings. Conclusion: Early stages and atypical features of NMS may be variable in presentation and clinical course. The absence of muscle rigidity may not rule out NMS. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment. Termination of dantrolene therapy may not be necessary during rhabdomyolysis and elevated aminotransferase levels.

Keywords

Atypical Neuroleptic Malignant Syndrome; Haloperidol; Ziprasidone; Dantrolene; Rhabdomyolysis; Creatinine Phosphokinase; Aminotransferase

Conflicts of Interest

The authors declare no conflicts of interest.

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