ABSTRACT 342

Abstract

Background and aims: Neuroleptic malignant syndrome (NMS) is a rare, life-threatening condition triggered by the use of antipsychotic agents. Scanty reports exist of its occurrence in children mostly in the setting of therapy with these drugs. Differentiating this condition from drug induced catatonia is critical to prevent organ damage. Aims: This report highlights a three year old boy who presented with accidental poisoning with an organophosphorus compound and subsequently developed NMS after treatment with haloperidol to control agitation. Family’s consent was taken. Methods: A three year old boy was admitted with toxic ingestion of an unknown organophosphorus compound. Acute cholinergic syndrome was present with respiratory failure requiring mechanical ventilation. Decontamination was completed and atropine and pralidoxime were administered. After an initial response lasting 36 hours, persisting muscle fasciculations necessitated further pralidoxime infusions. Agitation, delirium, and tremors increased over the next 2 days. Both parenteral and oral haloperidol (0.2mg/kg/day) had to be administered to control his symptoms. Results: Over the next 48 hours, he developed spiking fever, autonomic dysregulation, diaphoresis, lead-pipe rigidity, and tremors associated with elevated creatine kinase (453 IU/L). Toxicology screen, infection screen, brain MRI and EEG were all normal. Liver and renal function tests were normal. A diagnosis of NMS was made. Haloperidol was stopped, and diazepam, diphenhydramine, and trihexiphenidyl were added. He responded well with complete resolution of symptoms within the next 3 days. Conclusions: NMS should be considered in any patient displaying the typical symptoms after antipsychotic drugs. Large doses and parenteral use are particular risk factors. Prompt recognition may be life-saving in this uncommon condition in children.