Clinical image | DOI: https://doi.org/10.31579/2690-4861/410
Department of Maxillofacial Surgery Hospital of Specialities; CHU Ibn Sina, Av. Abderrahim Bouabid, Rabat-Morocco/ Faculty of Medicine and Pharmacy of Rabat. Mohammed V University; Imp. Souissi 10100, Rabat, Morocco.
*Corresponding Author: Rajaa El Azzouzi, Department of Maxillofacial Surgery Hospital of Specialities; CHU Ibn Sina, Av. Abderrahim Bouabid, Rabat-Morocco.
Citation: Rajaa E. Azzouzi, Bouchra Dani, Malik Boulaadas, (2024), Macroglossia Revealing a Neuroleptic Malignant Syndrome: a Clinical Images, International Journal of Clinical Case Reports and Reviews, 16(5); DOI:10.31579/2690-4861/410
Copyright: © 2024, Rajaa El Azzouzi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 26 February 2024 | Accepted: 05 March 2024 | Published: 11 March 2024
Keywords: macroglossia; tongue injury; neuroleptic malignant syndrome
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Figure 1: Images showing macroglossia with a tongue laceration during muscle spasm attacks.
Neuroleptic malignant syndrome is a rare and potentially fatal side effect that can occur in response to treatment with antipsychotic drugs. It is characterized by four main symptoms: Impaired mental function, fever, muscle rigidity and autonomic dysfunction. We report the case of a 20-year-old patient, followed for psychosis, in whom a new therapeutic line was adapted 3 days ago: Largactil (chlorpromazine) and Haldol (Haloperidol), who presented to the maxillofacial emergency department with tongue laceration. Clinical examination revealed in an agitated, uncooperative tachycardic and apyretic patient, revealed a generalized muscular spasm associated with trismus attacks, causing tongue injuries due to the installed macroglossia, A biological assessment, including a blood count, coagulation test, with renal assessment, calcium level, albumin level and CPK (creatine phosphokinase) level, revealed a very high CPK level (CPK= 1727 UI/L), the diagnosis of neuroleptic malignant syndrome was suspected, the patient was initially admitted to the operating room for wound suturing under general anaesthesia, and was then admitted intubated to the intensive care unit after interruption of neuroleptic treatment, he benefited from a continuous rehydration regimen and clinical and biological monitoring, the evolution was marked in 7 days by complete regression of macroglossia, cessation of muscle spasm attacks, wound healing and normalization of the biological assessment, the patient was transferred directly to the psychiatric unit for further management. When a diagnosis of neuroleptic malignant syndrome is suggested by the clinical history and semiological findings, the most critical strategy in therapeutic management is to discontinue the suspected pharmacological compound. There is little reason to delay discontinuation, even with regard to obtaining laboratory results for CPK or other indices: there is no need to delay discontinuation in order to seek confirmatory evidence in the context of a more suggestive clinical picture.
No conflicts of interest have been declared by the authors.
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