Neuroleptic malignant syndrome associated with acute organophosphate poisoning: Case report

Nancy Y. Angulo , Paula A. Castaño, Crhistian C. Gómez , Santiago Quintero , .

Keywords: Neuroleptic malignant syndrome, insecticides, organophosphate, cholinesterases, bromocriptine, fever, rhabdomyolysis

Abstract

Neuroleptic malignant syndrome is a rare and potentially fatal clinical condition frequently associated with the use of antipsychotics. In the literature, there is only one case report associated with the intake of organophosphates.
We present the case of a patient who presented with a clinical picture compatible with neuroleptic malignant syndrome, after the ingestion of an organophosphate (chlorpyrifos). A 57-year-old man who consulted for attempted suicide, acute deterioration of consciousness, torpid neurological evolution, and associated autonomic instability associated with rigidity, persistent hyperthermia, and elevated CPK. Bromocriptine treatment was offered, which resolved the clinical picture. The association with the ingestion of an organophosphate was established, and he was discharged without sequelae.
The diagnosis of neuroleptic malignant syndrome is clinical and should be considered in any case of exposure to substances that may lead to dysregulation of dopaminergic neurotransmission in order to initiate timely therapy and impact outcomes.

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References

Uprety A, Pantha B, Karki L, Nepal SP, Khadka M. Prevalence of intermediate syndrome among admitted patients with organophosphorous poisoning in a tertiary care hospital. JNMA J Nepal Med Assoc. 2019;57:340-3. https://doi.org/10.31729/jnma.4569

Ochi G, Watanabe K, Tokuoka H, Hatakenaka S, Arai T. Neuroleptic malignant-like syndrome: A complication of acute organophosphate poisoning. Can J Anaesth. 1995;42:1027-30. https://doi.org/10.1007/bf03011077

Tse L, Barr AM, Scarapicchia V, Vila-Rodríguez F. Neuroleptic malignant syndrome: A review from a clinically oriented perspective. Curr Neuropharmacol. 2015;13:395-406. https://doi.org/10.2174/1570159x13999150424113345

Modi S, Dharaiya D, Schultz L, Varelas P. Neuroleptic malignant syndrome: Complications, outcomes, and mortality. Neurocrit Care. 2016;24:97-103. https://doi.org/10.1007/s12028-015-0162-5

Singhai K, Kuppili PP, Nebhinani N. Atypical neuroleptic malignant syndrome: A systematic review of case reports. Gen Hosp Psychiatry. 2019;60:12-9. https://doi.org/10.1016/j.genhosppsych.2019.06.009

Torres-Altoro MI, Mathur BN, Drerup JM, Thomas R, Lovinger DM, O’Callaghan JP, et al. Organophosphates dysregulate dopamine signaling, glutamatergic neurotransmission, and induce neuronal injury markers in striatum: Organophosphates dysregulate striatum. J Neurochem. 2011;119:303-13. https://doi.org/10.1111/j.1471-4159.2011.07428.x

Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry. 1985;142:1137-45. https://doi.org/10.1176/ajp.142.10.1137

Singh N, Lawana V, Luo J, Phong P, Abdalla A, Palanisamy B, et al. Organophosphate pesticide chlorpyrifos impairs STAT1 signaling to induce dopaminergic neurotoxicity: Implications for mitochondria mediated oxidative stress signaling events. Neurobiol Dis. 2018;117:82-113. https://doi.org/10.1016/j.nbd.2018.05.019

Nakamagoe K, Watanabe M, Takeda T, Mizutani T, Tamaoka A. Parkinsonism with organophosphate poisoning. BMJ Case Rep. 2009;2009:bcr0420091766. https://doi.org/10.1136/bcr.04.2009.1766

Hsieh BH, Deng JF, Ger J. La inhibición de la acetilcolinesterasa y el síndrome extrapiramidal: una revisión de la neurotoxicidad de los organofosforados. Neurotoxicology. 2001;22:423-7.

How to Cite
1.
Angulo NY, Castaño PA, Gómez CC, Quintero S. Neuroleptic malignant syndrome associated with acute organophosphate poisoning: Case report. biomedica [Internet]. 2022 Sep. 2 [cited 2024 May 11];42(3):445-9. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/6428

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Published
2022-09-02
Section
Case presentation

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