A CASE REPORT OF NEUROLEPTIC MALIGNANT SYNDROME FOLLOWING AN OPERATION FOR ACUTE APPENDICITIS

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  • 虫垂炎術後に併発した悪性症候群の1例

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Abstract

A 41-year-old man with mental retardation, deaf and dumb underwent appendectomy under spinal anesthesia for gangrenous appendictis with ileocecal abscess at elsewhere. On the 4th postoperative day, intractable high fever, coma, fasciculation and rigidity on the extrimities developed and rapidly progressed. The patient was transferred to the hospital. We suspected an intraabdominal remnant abscess, but exploratory laparotomy under general anesthesia revealed no evidence of remnant abscess. A lumber puncture also yielded no abnormal findings of cerebrospinal fluid. He died of sudden cardiac arrest on the next day after the second operation. It was found postoperatively that he had been treated with neuroleptic drugs for a long period at slightly manic state, and he was diagnosed as neuroleptic malignant syndrome according to his clinical course and its diagnostic criteria. In this case we failed to make the correct diagnosis preoperatively, because postoperative high fever was considered due to remnant abscess; we had difficulty in evaluation of coma and abdominal symptoms for his mental retardation, deaf and dumb; and we did not confirm his former treatment with neuroleptic drugs (and he had not been diagnosed as psychosis).

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