NEUROLEPTIC MALIGNANT-LIKE SYNDROME - A COMPLICATION OF ACUTE ORGANOPHOSPHATE POISONING

We report a 60-yr-old woman with schizophrenia, who manifested a neuro leptic malignant (NM)-like syndrome after acute organophosphate poison ing (OPP). She attempted suicide by ingesting 40% emulsions of DMTP ih ydro-5-methoxy-2-oxo-1,3,4-thiadizol-3-yl-methyl O,O-dimethyl phosphor odithioate) 100 ml. On admission, she was unconscious and demonstrated convulsions, depressed respiratory movements, miosis and profuse sali vation. Plasma cholinesterase concentration (842 IU . L(-1)) was very low and OPP was diagnosed. She war treated with gastric lavage, atropi ne and pralidoxime (PAM). By the seventh day after admission, symptoms of OPP disappeared and serum ChE had recovered to a sub-normal level on the 13th day, she demonstrated coma, high fever (41.0 degrees C) an d lead-pipe rigidity. Serum CPK was increased (1631 IU . L(-1)). Dantr olene sodium iv was administered for three days Body temperature began to decrease in 24 hr, and her consciousness, muscle rigidity and othe r neurological symptoms returned to normal by the 16th day after admis sion. She was discharged from the hospital without sequelae 55 days af ter admission. We conclude that OPP can predispose to an NM-like syndr ome and that dantrolene may be effective in the management.