Psychiatria pre prax 2/2019

Malignant neuroleptic syndrome with an associated respiratory-tract infection in a patient with a first psychotic episode

We present the case report of a 22-year-old patient admitted for his first psychiatric hospitalization with a diagnosis of acute polymorphic psychotic disorder with symptoms of schizophrenia. At the beginning of his hospitalization at a regional psychiatric ward, the patient‘s CRP levels and body temperature rose. Poor response to antipsychotic therapy and the necessity of electroconvulsive therapy (ECT) resulted in the patient being transferred to our department. Numerous diagnostic examinations were conducted in order to determine the origin of the progressing infection. During the follow-up blood tests, an increase in creatine kinase and myoglobin was noted, which, in combination with the persisting infection, resulted in the patient being transferred to the ICU. After a decrease in body temperature and sub-compensation of laboratory parameters, the patient was retransferred to our department where electroconvulsive therapy was initiated, with subsequent administration of oral olanzapine.

Keywords: psychosis, malignant neuroleptic syndrome, electroconvulsive therapy, infection, fever