[Hyperthermia with acute rhabdomyolysis in a psychotic treated with neuroleptics]

A 36 year old psychotic man receiving treatment with slow-release pipotiazine and trihexyphenidyl developed nine days after addition of droperidol signs suggestive of a malignant neuroleptic syndrome: altered general condition, diffuse hypertonia, akinesia, fever and vomiting. Results of biologic tests and a muscle biopsy were suggestive of a severe rhabdomyolysis. Cessation of neuroleptic therapy and the administrative of nifedipine brought a gradual return return to normal conditions, and progressively increasing doses of neuroleptic could be given without complications 12 days later. Onset of hyperthermia during neuroleptic treatment raises two questions: 1) is the etiology related to a malignant neuroleptic syndrome or acute catatonia, or a heat stroke? 2) to what extent are neuroleptics responsible for these disorders?