Gas-Producing Escherichia coli Fasciitis in a Patient With the Neuroleptic Malignant Syndrome

Abstract

To the Editor.— The neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal reaction to major tranquilizers. It is characterized by hyperpyrexia, muscle rigidity, altered consciousness, and autonomicdysfunction. 1,2 We report a dramatic case of the NMS complicated by bilateral anterior tibial compartment syndromes that were infected by gasproducing Escherichia coli . Report of a Case.— A 29-year-old man was admitted to the Bernalillo County Mental Health Center, Albuquerque, with the diagnosis of acute paranoid schizophrenia. During a 12-hour period, he received 90 mg of haloperidol and 100 mg of chlorpromazine orally. Two hours later, he was comatose, hypotensive, hyperpyrexic (rectal temperature, 41.3 °C), and rigid, with clonic jerking movements, and was transferred to the University of New Mexico Hospital, Albuquerque. His creatine kinase level was 220,000 IU/L, his uric acid level was 25.2 mg/mL, and the scanty urine specimens were positive for myoglobin and initially yellow and then burgundy-colored