Neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to
neuroleptic drugs, which is potentially fatal. It has been occasionally reported that NMS occurs subsequently after surgery. We report a case of a 53-year-old male patient who developed NMS following cardiac surgery due to the resumption of
zotepine. The patient was attacked with
hyperthermia, sweating, significant shivering, trembling of the fingers, disturbed consciousness and extreme
muscle rigidity after the resumption of
zotepine. Furthermore, laboratory measurements revealed increased levels of serum blood
urea nitrogen,
creatinine and
creatine phosphokinase. In addition, elevation in white blood cell counts and myoglobinemia were also observed. After a diagnosis of NMS was established, administration of
zotepine was stopped and treatments with administration of
dantrolene and a large amount of fluid infusion intravenously were started. Following these treatments, the clinical symptoms subsided and the laboratory findings improved without need for
hemodialysis.
Dantrolene, which is able to effectively impede the abnormal flow of
calcium from the sarcplasmic reticulum into the muscle cytoplasm, was beneficial to reduce the clinical symptoms of NMS. We hereby present a patient with NMS following cardiac surgery, and discuss its subsequent management.