정신약물에 의한 치명적 이상고열증

Fatal Hyperpyrexia with Chlorpromazine and Benztropine Therapy

This case of lethal hyperpyrexia is associated with a drug combination of chlorpromazine and benztropine intended to control aggressive behaviors and other psychotic symptoms. A 22 year old, single, Caucasian male with a history of mild mental retardation and repeated mental hospital admissions with violent behaviors, developed severe hyperpyrexia while he was exposed to a high ambient temperature (100° F ). His body temperatures climbed as high as 108°F (42. 2°C) and the hyperthermia was followed by cardiovascular collapse, multiple complications (hypostatic bronchopneumonia and hypoxic encephalomalacia), and finally death. The etiologic considerations, symptomatology, thermoregulatory mechanisms, differential diagnosis, preventive measures, and the appropriate treat ment for the hyperpyrexia were described. The extensive literature review was also discussed in treatthis article. The disease is characterized by sudden, usually unexpected onset, and mortality remains depress-ingly high. The phenomenon of drug-induced hyperpyrexia has been too little discussed, and there have been too few case reports made regarding this severe illness and its often lethal consequences. However, various neuroleptics, antiparkinsonian drugs, antidepressants and anesthetics have been associated with the disease. The case described in this article may be the first case report of the lethal hyperpyrexia with neuroleptic and antiparkinsonian drug combination in the Korean Neuropsychiatric Journal and one of few case reports regarding the drug-induced fatal hyperpyrexia. In contrast to the paucity of the drug-induced hyperpyrexia reports, the disease, while seldom recognized, is not uncommon; this has been previously recognized by several authors. Therefore, the education of mental health professionals, patients, and patient’s families concerning the preventive measures, appropriate therapy, and the dangers of using phenothiazine and anticholinergic combination therapy during the summer is special imperative. Acknowledgement： Special thanks to Robert H. Chaney, M.D. at Pomona V alley Community Hospital for supplying detailed medical records regarding the patients’ICU therapy for hyperpyrexia; and Dr. John Sramek, Jr. at the USC Dept, of Pharmacology, and Lucille Clippinger, RN for assisting in the article searches.