Neuroleptic malignant syndrome (NMS) is a rare pathologic condition associated with serious adverse reactions to neuroleptics. We reported a case of gas-producing phlegmon that spread from the floor of the mouth to the cervical region and was accompanied by NMS.
A 20-year-old man was referred to us because of painful swelling of the lower left buccal and cervical regions, which caused slight dyspnea. A computed tomographic scan revealed gas accumulation in the oral and cervical fascial spaces. A diagnosis of gas-producing phlegmon spreading from the floor of the mouth to the cervical region was made. After incision and drainage under general anesthesia with endotracheal intubation, the patient remained in intensive care and was given antibiotics and neuroleptic agents intravenously. Gradually, the swelling disappeared, and the endotracheal tube was removed. After extubation, hyperthermia, tremor, tachycardia, hypertension, tachypnea, sialorrhea, and altered consciousness developed. Laboratory results at that time revealed a WBC count of 11, 230/μl and a CK level of 11, 8051U/I, suggesting a diagnosis of NMS caused by haloperidol. He was treated with dantololene (60 mg) and bromocriptine (7.5 mg) and wash-out therapy of myoglobin to avoid acute renal failure. NMS gradually resolved.
In severe infections, management of general complications and adverse reactions as well as rapid drainage and appropriate antibiotic therapy is essential.
