Abstract
Introduction: Neuroleptic malignant syndrome (NMs) is a life-threatening disease more often considered than truly diagnosed. the NMs is a life-threatening neurologic emergency associated with the use of antipsychotic drugs and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. case report: A 69-year-old wheel chair bound male with past medical history of severe vascular dementia with behavioral problems, schizoaffective disorder referred from nursing home due to fever for 1 day. According to his room-mate, his baseline mental status use to be drowsy and disoriented. Vitals showed temperature 102°F (38.8°c), tachycardia, high blood pressure 140/90 mmHg, tachypnea and low oxygen saturation of 87% on room air. Arterial blood gases showed hypoxia and respiratory alkalosis with high A-a gradient. Also suspected infection due to leukocytosis with neutrophilia. However, we kept neuroleptic malignant syndrome (NMs) in mind since patient was taking haloperidol for episodic agitation although haloperidol dose was unchanged and no new drugs were added. When total creatine kinase came back as 3142 IU/L, he was managed successfully with dantrolene and amantadine.
Highlights
Hypereosinophilic syndrome (HES) can be a multisystem disorder due to direct end-organ damage by eosinophilia, and can rarely present with life-threatening features
We present a case of multi-organ failure secondary to eosinophilia related to medications
Case report: A 66-year-old woman with a recent diagnosis of asthma on montelukast, presented with excruciating pains of sudden onset in her lower limbs, and on admission, she was found to be in multi-organ failure
Summary
Eosinophilia refers to an absolute count of eosinophils >500/ml in the peripheral blood [1]. The patient described excruciating shooting pains in all muscle groups in her right leg, to the point that on presentation she was unable to weight bear, and had to be wheeled into the department. The patient was on montelukast 10 mg once daily and lansoprazole 30 mg once daily On further questioning, she admitted to having had recurrent chest infections and asthma exacerbations over the last few months prior to her current presentation, requiring steroids and antibiotics every 2–3 weeks. On further follow-up post-montelukast cessation and steroid withdraw, patient remained well and asymptomatic, with repeated bloods with normal blood count and eosinophilic values, having not required further treatment and in particular immunosuppression, making montelukast the main differential diagnosis for the patient’s life threatening presentation
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