Zuclopenthixol
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Neuroleptic malignant syndrome: case report A 14-year-old girl developed neuroleptic malignant syndrome (NMS) during treatment with zuclopenthixol for acute mania. The girl, who was referred from a tertiary mental health hospital, presented with concerns of very high-grade fevers, convulsions and altered mental status for a week. Anamnesis revealed that she had been diagnosed with acute mania, for which she had been receiving IM zuclopenthixol [Clopixol-Acuphase; zuclopenthixol acetate] 25mg stat. Forty-eight hours following the administration of zuclopenthixol, she developed high-grade fevers, which persisted over several days. She also developed recurrent generalised tonic-clonic convulsions lasting about 5 minutes, associated with frothing from the mouth, post-ictal sleepiness, alteration in mental state, and loss of bladder and bowel control. The girl started receiving treatment with paracetamol 1g three times daily; however, no reduction in temperature was noted. Malignant hyperthermia was suspected and she was referred for specialised neurology care. She was admitted to the neurology unit and examination showed a sick-appearing young girl, tremulous and drooling saliva. Her Glasgow coma scale was 8/15, and vital examination revealed appreciable nuchal rigidity and generalised lead-pipe rigidity with decreased muscle power in all her limbs. Complete blood count and liver enzymes were determined. CNS infection was ruled out. The findings confirmed a diagnosis of NMS. Zuclopenthixol was discontinued. She further received treatment with phenytoin, dantrolene and bromocriptine through a nasogastric tube. Supportively, urinary catheter was also inserted. She received treatment with cold tepid sponging, cold intravenous crystalloid fluid and axillary ice packs. She was closely monitored and received physical therapy daily during hospitalisation. Within a week, she became afebrile and GCS had improved over a period of 3 weeks. She attained complete neurological and physical recovery and remained calm and free of psychiatric symptoms. She was discharged later. Kiyingi M, et al. Neuroleptic malignant syndrome: Early diagnosis saves lives in low-resource settings. International Medical Case Reports Journal 13: 359-362, 24 Aug 2020. 803502925 Available from: URL: http://doi.org/10.2147/IMCRJ.S270332
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Reactions 26 Sep 2020 No. 1823
