抗精神病药物恶性综合征(NMS)是一种罕见的危及生命的疾病,与使用抗精神病药物有关。此病例报告描述了一名30岁出头的男性患者发烧,呼吸困难,下肢无力,最终诊断为NMS,尽管没有肌肉僵硬。在检查中,他发烧了,心动过速,血氧饱和度为88%,血压升高。听诊时,发现了两个肺的弥漫性蠕动。神经评估显示下肢运动强度为3/5,没有刚性,感官损失,或者小脑体征.据指出,在过去的一年里,他一直在服用不规则的非典型抗精神病药物。实验室调查显示白细胞增多,转氨酶升高,食夜动物,肌酸磷酸激酶(CPK)升高,还有血清肌酐.由于缺乏肌肉僵硬,最初未考虑NMS。然而,患者后来出现自主神经失调表现,如麻痹性肠梗阻。一旦排除了器质性原因,NMS被诊断。支持治疗包括23个周期的血液透析和结肠减压治疗假性梗阻。他接受了静脉输液和多巴胺受体激动剂药物治疗。NMS通常表现为发烧,肌肉僵硬,精神状态改变,和自主神经不稳定;然而,该患者没有肌肉僵硬是一个独特且不寻常的特征。
Neuroleptic malignant syndrome (NMS) is a rare life-threatening condition associated with the use of antipsychotic medications. This case report describes a male patient in his early 30s who presented with fever, breathlessness, and lower limb weakness, ultimately diagnosed with NMS despite the absence of muscular rigidity. On examination, he was febrile, tachycardic, and tachypneic with an oxygen saturation of 88% and elevated blood pressure. On auscultation diffuse crepitations in both lungs were revealed. Neurological assessment indicated motor strength of 3/5 in both lower limbs, without rigidity, sensory loss, or cerebellar signs. It was noted that he was on irregular atypical antipsychotic medication for the past one year. Laboratory investigations revealed leukocytosis, elevated transaminases, dyselectrolytemia, elevated creatine phosphokinase (CPK), and serum creatinine. NMS was not initially considered due to the lack of muscular rigidity. However, the patient later developed autonomic dysregulation manifestations, such as paralytic ileus. Once organic causes were excluded, NMS was diagnosed. Supportive therapy included 23 cycles of hemodialysis and colonic decompression for pseudo-obstruction. He was treated with intravenous fluids and dopamine receptor agonist medications. NMS usually presents with fever, muscular rigidity, altered mental status, and autonomic instability; yet, the absence of muscular rigidity in this patient is a distinctive and unusual feature.