Neuroleptic Malignant Syndrome on Chronic Trifluoperazine Therapy: A Diagnostic Dilemma

Area of Science:

• Neuroscience
• Pharmacology
• Clinical Medicine

Background:

• Neuroleptic malignant syndrome (NMS) is a rare, life-threatening adverse drug reaction.
• Antipsychotic medications are commonly associated with NMS.
• Diagnosis can be challenging, especially in patients on stable regimens.

Purpose of the Study:

• To report a case of NMS in a patient with chronic antipsychotic use.
• To highlight the diagnostic challenges and importance of early recognition of NMS.
• To emphasize the need to exclude infectious causes before diagnosing NMS.

Main Methods:

• Case report of a 62-year-old male with chronic trifluoperazine use.
• Clinical presentation included fever, rigidity, and altered mental status.
• Diagnosis confirmed by elevated creatine kinase and Levenson's criteria, after excluding sepsis/meningoencephalitis.

Main Results:

• The patient presented with symptoms suggestive of NMS.
• Diagnostic workup confirmed NMS, ruling out infectious etiologies.
• The patient improved with supportive care, bromocriptine, and lorazepam.

Conclusions:

• NMS diagnosis can be difficult in patients on stable antipsychotic therapy.
• Prompt recognition and exclusion of infectious causes are vital.
• Effective management involves supportive care and specific treatments like bromocriptine.