Acute Mesenteric Ischemia: A Rare Complication of Neuroleptic Malignant Syndrome

抗精神病藥物惡性症後群是一種由抗精神病藥物所引起的罕見情況。此症後群發生充滿了不可預測性，臨床上是以高體溫、僵硬的神智狀態改變以及自主神經不穩定來表現。其致死率約15~25%，所以對此症狀的認知是很重要的。截至目前為止，我們對於抗精神病藥物惡性症後群的發生情況及病理生理機轉仍不了解。許多伴隨抗精神病藥物惡性症後群的併發症曾被報告過，諸如：心肌梗塞、急性腎衰竭、猛爆性肝衰竭、血小板低下、腔室症候群、大量小腸出血等。無論如何，查閱相關文獻，僅有一例併發致死的缺血性結腸炎曾被報告過。本院報告一例患有精神分裂症的患者，近兩年來服用Olanzapine，併發了抗精神病藥物惡性症後群。除了典型的症狀之外，在此次的住院中，我們也同時觀察到了病人同時伴有小腸缺血性壞死。我們描述了該病人的發病過程，處理與可能的致病機轉。本篇的報告目的在指出，抗精神病藥物惡性症後群也可能併發急性腸繫膜缺血，以及對此罕見情況所需的特別注意。

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並列摘要

Neuroleptic malignant syndrome (NMS) is an uncommon and unpredictable complication of neuroleptic therapy which is characterized by hyperthermia, rigidity, altered mentation and autonomic instability. This complication is potentially lethal, with a mortality rate of 15 to 25%. However, the etiology of NMS and its pathophysiologic mechanisms remain uncertain. Many medical complications have been reported in conjunction with NMS, including myocardial infarction, leukoencephalopathy, acute renal failure, fulminant liver failure, thrombocytopenia, compartment syndrome and massive intestinal bleeding. However, only one case with NMS complicated with ischemic colitis has been reported. We report a patient with schizophrenia initially diagnosed at 34 years old who took olanzapine for about 2 years and developed NMS. In addition to the typical symptoms and signs of NMS, small bowel ischemic necrosis requiring surgical intervention occurred during the episode. We describe the clinical course, the management and the possible mechanism in this patient. This case indicates that NMS can be complicated by acute mesenteric ischemia and the need for awareness of this rare complication.

並列關鍵字

neuroleptic malignant syndrome ； mesentric ischemia ； olanzapine

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Acute Mesenteric Ischemia: A Rare Complication of Neuroleptic Malignant Syndrome

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