Levodopa
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Levodopa Parkinsonism-hyperpyrexia syndrome and acute psychosis: 2 case reports
A report described a 73-year-old man and an approximately 79-year-old woman, who developed parkinsonism-hyperpyrexia syndrome and acute psychosis during levodopa for Parkinson’s disease, respectively [times to reactions onsets not stated; not all routes stated]. Case 1: The 73-year-old man, who had a 15-year history of Parkinson’s disease, was admitted due to neurosurgical evacuation of traumatic subdural haematoma. His parkinsonism had deteriorated in the previous 3 months despite the treatment with levodopa dosage 1200mg/day [initial route not stated]. During the postoperative period, his bradykinesia and rigidity markedly worsened. Thus, the dose of levodopa increased, and he received treatment with unspecified dopamine agonists. However, no clear improvement was observed. He became confused, febrile and diaphoretic. Examination showed generalised rigidity and bradykinesia. Blood tests revealed high muscle enzyme levels and markers of acute renal failure. His response to the dopaminergic therapy remained minimal. Subsequently, he developed shortness of breath and tachycardia. Then, he was diagnosed with pulmonary embolism, and he was admitted to the ICU. A diagnosis of parkinsonism-hyperpyrexia syndrome was considered. Thereafter, he received levodopa via a nasogastric tube and intense physiotherapy implemented. Eventually, a gradual improvement was noted; however, his daily functioning was still noted to be impaired despite continuous dopaminergic therapy. Case 2: The 79-year-old woman, who had Parkinson’s disease, was brought by her caregiver to the hospital emergency room due to marked agitation and paranoid ideation at the age of 80 years. She had physically attacked a staff member at the nursing home where she had been recently placed. One year prior (at the age of 79 years), she developed visual hallucinations, which was well controlled with quetiapine. She had developed frequent delusions with loss of insight in the previous 6 months. On admission to the Neurology ward, she had been receiving levodopa 300mg per day and quetiapine. She was noted to have acute psychosis secondary to levodopa. Initially, dose of levodopa was halved. However, no any significant motor worsening or improvement in hallucinations or delusions was noted. Subsequently, quetiapine was switched to clozapine, prompting improvement in psychiatric symptoms. Then, the dose of levodopa was raised back to 300mg per day and clozapine was maintained. After a few months, she developed cognitive decline. Thus, she received rivastigmine. Simonet C, et al. Emergencies and critical issues in Parkinson’s disease. [Review]. Practical Neurology 20: 15-25, No. 1, Feb 2020. Available from: URL: http:// doi.org/10.1136/practneurol-2018-002075
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Reactions 12 Dec 2020 No. 1834
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