tetano
Editor, Senior Moderator
Cureus
. 2022 Aug 12;14(8):e27923.
doi: 10.7759/cureus.27923. eCollection 2022 Aug.
Atypical Neuroleptic Malignant Syndrome in a COVID-19 Intensive Care Unit
Joshua R Durbach[SUP] 1 [/SUP], Gerald Rosen[SUP] 2 [/SUP], Carolina De La Cuesta[SUP] 3 [/SUP], Seth Gottlieb[SUP] 4 [/SUP]
Affiliations
Abstract
Neuroleptic malignant syndrome (NMS) has been defined as a life-threatening neurologic emergency related to the use of antipsychotic medications. It is most often seen with high-potency (first-generation) antipsychotic medications and may occur after a single dose. There have been conflicting reports in the literature of an atypical NMS (ANMS) presentation, associated with lower-potency agents (second generation) antipsychotic medications. NMS is usually diagnosed with a tetrad of clinical symptoms although none of the tetrads is needed for diagnosis. We report a case of a patient admitted for severe acute syndrome coronavirus 2 (SARS-CoV2) pneumonia who developed probable ANMS. SARS-CoV2 also referred to as coronavirus disease 2019 (COVID-19) added another dimension of complication to patient care as we have, at this time, an incomplete understanding of the pathogenesis. We feel critical care clinicians should maintain broad differentials to clinical findings, during the use of multiple medications and not simply attribute the various presentations to COVID-19.
Keywords: critical care and internal medicine education; critical care anesthesiology; critical thinking; dantrolene; difficult diagnosis; medical intensive care unit (micu); neuroleptic malignant syndrome (nms); sars-cov-2; second generation induced neuroleptic malignant syndrome; severe covid-19.
. 2022 Aug 12;14(8):e27923.
doi: 10.7759/cureus.27923. eCollection 2022 Aug.
Atypical Neuroleptic Malignant Syndrome in a COVID-19 Intensive Care Unit
Joshua R Durbach[SUP] 1 [/SUP], Gerald Rosen[SUP] 2 [/SUP], Carolina De La Cuesta[SUP] 3 [/SUP], Seth Gottlieb[SUP] 4 [/SUP]
Affiliations
- PMID: 36110487
- PMCID: PMC9464418
- DOI: 10.7759/cureus.27923
Abstract
Neuroleptic malignant syndrome (NMS) has been defined as a life-threatening neurologic emergency related to the use of antipsychotic medications. It is most often seen with high-potency (first-generation) antipsychotic medications and may occur after a single dose. There have been conflicting reports in the literature of an atypical NMS (ANMS) presentation, associated with lower-potency agents (second generation) antipsychotic medications. NMS is usually diagnosed with a tetrad of clinical symptoms although none of the tetrads is needed for diagnosis. We report a case of a patient admitted for severe acute syndrome coronavirus 2 (SARS-CoV2) pneumonia who developed probable ANMS. SARS-CoV2 also referred to as coronavirus disease 2019 (COVID-19) added another dimension of complication to patient care as we have, at this time, an incomplete understanding of the pathogenesis. We feel critical care clinicians should maintain broad differentials to clinical findings, during the use of multiple medications and not simply attribute the various presentations to COVID-19.
Keywords: critical care and internal medicine education; critical care anesthesiology; critical thinking; dantrolene; difficult diagnosis; medical intensive care unit (micu); neuroleptic malignant syndrome (nms); sars-cov-2; second generation induced neuroleptic malignant syndrome; severe covid-19.