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Lethal neuroleptic malignant syndrome due to amisulpride
Frank Musshoff1, Elke Doberentz, Burkhard Madea
1University Hospital, Institute of Forensic Medicine, Rheinische Friedrich-Wilhems-University Bonn, Stiftsplatz 12, 53111, Bonn, Germany. f.musshoff@uni-bonn.de
Forensic Science, Medicine, and Pathology
|March 19, 2013
Summary
A fatal case of neuroleptic malignant syndrome (NMS) was linked to amisulpride. This severe adverse drug reaction caused hyperthermia, rigidity, and ultimately death, highlighting critical safety concerns.
Area of Science:
- Clinical Toxicology
- Pharmacovigilance
- Neurology
Background:
- Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening idiosyncratic reaction to antipsychotic medications.
- Early recognition and management are crucial for patient survival.
Observation:
- A 42-year-old male presented with seizures, progressing to unconsciousness, hypotonia, mydriasis, and rigidity.
- Severe hyperthermia (rectal temperature >42°C), metabolic acidosis, gasping respiration, and ventricular fibrillation were noted.
- Autopsy revealed cerebral and pulmonary edema, organ congestion, myocyte contraction bands, and hepatic fibrosis.
Findings:
- Toxicological analysis confirmed amisulpride (4.65 mg/l), biperiden (0.12 mg/l), imipramine (0.33 mg/l), and desipramine (0.68 mg/l) in peripheral blood.
- The clinical presentation and autopsy findings were consistent with amisulpride-induced NMS.
Implications:
- This case underscores the potential for amisulpride to trigger NMS, even at therapeutic or slightly elevated levels.
- Highlights the importance of monitoring for NMS symptoms in patients treated with amisulpride and other neuroleptics.
- Emphasizes the need for prompt medical intervention in suspected NMS cases to improve patient outcomes.
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