Neuroleptic Malignant Syndrome Associated with Lithium Toxicity

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Neuroleptic Malignant Syndrome (NMS) is a severe adverse drug reaction to neuroleptic medications.
• Lithium is a common mood stabilizer for bipolar disorder, often used alone or with other agents.
• Previous reports of lithium-associated NMS involved concurrent antipsychotic use, obscuring lithium's direct role.

Observation:

• A 74-year-old female with a 30-year history of bipolar disorder presented with fever and weakness.
• The patient developed NMS while on lithium monotherapy, with no other NMS-inducing agents administered.
• NMS diagnosis was confirmed based on the presence of three cardinal symptoms.

Findings:

• This case demonstrates lithium monotherapy as a potential cause of Neuroleptic Malignant Syndrome.
• It challenges the previous assumption that NMS associated with lithium requires concomitant antipsychotic use.
• The patient received supportive care, including intravenous fluids for sodium correction.

Implications:

• Clinicians should consider lithium monotherapy as a potential trigger for NMS.
• This finding necessitates a re-evaluation of NMS risk factors associated with lithium treatment.
• Further research is warranted to elucidate the mechanisms of lithium-induced NMS.