2021 Volume 38 Issue 5 Pages 748-751
A 48–year–old woman with schizophrenia presented with catatonic features, including fever, stupor, immobility, mutism, and staring, after a routine aripiprazole intramuscular injection. Fever and rigidity worsened after discontinuance of antipsychotics and benzodiazepines. Although the symptoms met the diagnostic criteria for neuroleptic malignant syndrome, a diagnosis of malignant catatonia was confirmed because treatment with diazepam infusion was dramatically effective, whereas dantrolene and bromocriptine were not beneficial. Malignant catatonia presents with fever and autonomic disturbance, in addition to catatonic features. Although the clinical presentation of antipsychotic–induced malignant catatonia and neuroleptic malignant syndrome is similar, the pathogenesis of the former is unclear. This case suggests that discontinuance of antipsychotics and benzodiazepines may induce malignant catatonia by the dysfunction of dopamine and GABA systems and the feedback pathway between the two systems. Antipsychotics and benzodiazepines are often used in combination. Malignant catatonia may be misdiagnosed as neuroleptic malignant syndrome.
