NEUROLEPTIC MALIGNANT SYNDROME OCCURRING AFTER AN EMERGENCY OPERATIONFOR TRAUMATIC DUODENAL PERFORATION - REPORT OF A CASE

Neuroleptic malignant syndrome (NMS) is a potentially fatal complicati on which may develop in psychiatric patients taking neuroleptic drugs. We report herein the success. ful treatment of a 33-year-old schizoph renic man, prescribed neuroleptic drugs, who underwent an emergency op eration for traumatic duodenal perforation with a retroperitoneal infe ction. Five days after the operation, he began to demonstrate clinical features consistent with NMS such as high fever, abnormalities in vit al signs, leukocytosis, and an elevated serum level of creatine phosph okinase; however, these findings were first presumed to be secondary t o either the preexisting tissue injuries or to postoperative complicat ions. A definite diagnosis of NMS was thus delayed until muscle rigidi ty and autonomic instability became evident. After a tentative diagnos is of NMS had been made, sodium dantrolene, a drug used specifically f or the treatment of NMS, was administered and the patient's condition remarkably improved. Since NMS can be induced by either interrupting t he course of neuroleptic drugs or by the additional administration of sedative drugs, and since its mortality rate is high if prompt and app ropriate treatment is not carried out, surgeons should bear in mind th e possibility of NMS developing postoperatively in psychiatric patient s.