Atypical form of neuroleptic malignant syndrome: A case report

A case of comatose consciousness disturbance in a 33-year-old woman following first-ever epileptic attack of grand-mal type and without focal neurologic events is presented. Results of examinations (neuroradiology, biochemistry, electrophysiology) were normal, whereas urine toxicology revealed phenothiazine in traces. Follow-up of laboratory parameters on day 2 of hospitalization showed a significant increase in the level of creatine phosphokinase to up to 75000 U/L, rhabdomyolysis (myoglobin up to 1750 muU/L), and development of renal insufficiency with moderate increase in liver enzymes, and tachycardia. On day 3 of hospital stay, heterohistory revealed the patient to have previously undergone psychiatric treatment, and to have received a depot formulation of flufenazine (50 mg) with atypical antipsychotic olanzapine (20 mg) on the day of hospital admission. Other possible causes of the mentioned disturbances were ruled out by extensive clinical examination, and the authors consider the patient suffered an abortive form of neuroleptic malignant syndrome (absence of rigidity and hyperpyrexia) as a consequence of the uncritical use of a combination of an atypical antipsychotic (olanzapine) and a typical neuroleptic, especially as a depot formulation (flufenazine), which has not yet been reported in the available literature.