Journal
CUREUS JOURNAL OF MEDICAL SCIENCE
Volume 13, Issue 6, Pages -Publisher
SPRINGERNATURE
DOI: 10.7759/cureus.15818
Keywords
neuroleptic malignant syndrome (nms); subtypes of catatonia; clinical case report; atypical antipsychotic; schizophrenia and other psychotic disorders; adverse event; diferential diagnosis; dantrolene; consultation liaison psychiatry; emergency psychiatry
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The clinical presentations of NMS and MC are similar, posing a diagnostic challenge. The patient initially diagnosed with NMS showed improvement after treatment but still had symptoms like rigidity, leading to a revised diagnosis of MC.
The clinical presentations of neuroleptic malignant syndrome (NMS) and malignant catatonia (MC) are similar, posing a diagnostic challenge. Here, we present a 58-year-old Caucasian male who presented to the emergency department with an altered mental state, fever, tachycardia, and rigidity. Labs were remarkable for elevated creatine phosphokinase (CPK) and leukocytosis. The patient was on a regimen of clozapine and cariprazine to manage schizophrenia, lorazepam to treat catatonia, and mirtazapine to treat insomnia and appetite stimulation. The patient was initially diagnosed with NMS after common metabolic, infectious, and substance-induced etiologies were ruled out. Within 72 hours of receiving dantrolene and lorazepam, the patient's fever, tachycardia, and other laboratory abnormalities resolved. However, when the patient's rigidity, waxy flexibility, mutism, and stupor persisted, the diagnosis was reconsidered and changed to MC. Our case discusses the overlapping clinical presentations of NMS and MC, demonstrating a diagnostic challenge.
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