[Atypical neuroleptic malignant syndrome]

Mr A ..., 38 years old, follow up for five years for an obsessional nevrosis, hospitalized for a serious breakdown with experiences of derealization, discordance and apragmatism, was treated with haloperidol (15 mg), cyamemazine (200 mg), aenethol trithione (25 mg), associated with clorazepate (150 mg), fluvoxamine (300 mg), trimipramine (200 mg). One month later, the appearance of an extrapyramidal syndrome induced a treatment with biperidone (2 mg). The following day, he was in a state of sub-confusion with temporo-spatial disorientation and anxious perplexity. The extrapyramidal syndrome was evident with major hypertonia and generalized shaking. The appearance of bedsores on the heels, and vesicular symmetrical lesions on the ear lobes evoked a toxidermia. A large muscular atrophy of the lower limbs inducing an important muscular weakness and rising of the seric C.P.K. up to 12300 UI/l complete the clinical picture. One could notice the absence of any general symptoms, particularly a persisting apyrexia. The paraclinical evaluation was normal with no indication of renal deficiency. The treatment with neuroleptics was stopped but in spite of the rising of biperidone (8 mg), then giving trihexyphenidyle (30 mg), the extrapyramidal syndrome regressed only after 2 months, the seric C.P.K. and the dermatologic lesions within a month. Through a brief review of literature, the authors question the unicity of the malignant syndrome. If hypertonia is quite constant, the rising of the seric C.P.K. is aspecific and hyperthermia is inconstant. A few theoric informations differentiate extrapyramidal symptoms with fever and neuroleptic malignant syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)