[Hyperpyrexia following poisoning with a monoamine oxidase inhibitor]

A 35-year old woman took 1 gram of isocarboxazide (Marplan) with suicidal intent. She was admitted to hospital approximately six hours later with nystagmus, generalized hypertonia and jaw trismus. Four hours after admission, she became comatose with poor ventilation, increasing rigidity of all muscles and temperature rising to 41.1 degrees C. She was intubated and ventilated. Dantrolen was used for muscular relaxation but because of minor unfavourable experience with dantrolen pancuron was employed instead. After this, the temperature fell and the patient became relaxed. After two days, she was extubated and transferred to psychiatric care in a normal physical state. It is concluded that a non-depolarizing neuromuscular blocking drug should be used in patients with hyperpyrexia caused by MAOI overdose, because of the generally more favourable experience with these drugs and because of the potential hepatoxicity of dantrolen.