[A case of malignant syndrome with leukoencephalopathy due to cocaine abuse]

We report a rare case of malignant syndrome with leukoencephalopathy due to cocaine abuse. The patient was a 22-year-old man. After nasally ingesting 4.2 g of cocaine, he developed coma, high grade fever of 39 degrees C, excessive sweating, muscular rigidity, and elevation of CK to 61,240 mU/ml. Although these symptoms improved in about 2 weeks, diffuse low density area of the cerebral white matter was observed in CT scan, and T2-weighted MRI revealed a high signal intensity area. Since disorientation and abnormal behavior appeared on the 24th hospital day after a lucid interval, sulpiride and haloperidol were administered. The patient again had fever, akinetic mutisn, severe muscular rigidity and excessive sweating. This patient has malignant syndrome associated with a wide-ranging lesion of the cerebral white matter as a result of cocaine abuse. And then antipsychotic drugs were administered for mental symptoms that recurred after a lucid interval, and second bouts of neuroleptic malignant syndrome occurred. There have been only a few reports on malignant syndrome due to cocaine, and there have been no reports on leukoencephalopathy due to cocaine or malignant syndrome.