Abstract
An 82 -year-old male with end-stage renal failure suffering from neuromyelitis optica. As
weakness and decreased sensation developed in the patient’ s leg, his previous doctor performed
steroid pulse therapy. Although these symptoms recovered, gait disturbance continued.
Therefore, on X- 28 day, he transferred to our hospital for rehabilitation. Upon admission,
he was administered of 15 mg/day steroid, 30 mg/day bethanechol and ureteral catheterization
was continued. On X-day, general excessive sweating and shivering suddenly occurred
after prolonged constipation. Body temperature was 36 . 5 ℃ , and blood pressure was 137 / 81
mmHg . Thus, vital signs were normal. Subsequently, sinus bradycardia （40 /min） developed.
These symptoms were indicative of cholinergic crisis. However, choline esterase inhibitors
were not used in this case as bethanechol itself was assumed the cause of the cholinergic
crisis. Immediate discontinuation of this drug stopped these symptoms and the activity of
choline esterase did not change. Thus, constipation-triggered bethanechol-induced cholinergic
crisis was suspected.
