S216. CASE REPORT OF TREATMENT OF NEUROLEPTIC MALIGNANT SYNDROME IN CHILD ADOLESCENT

Abstract Background Neuroleptic Malignant Syndrome is a rare clinical syndrome occurring due to idiosyncratic reaction after use of neuroleptics. We report a case of neuroleptic malignant syndrome in an adolescent patient with schizophrenia after treatment with antipsychotics. Methods Case report. Results A 15-year-old male Schizophrenic patient was admitted to the psychiatric closed ward due to worsening of psychotic symptoms on July of 2017. Pineal cystoma and pituitary microadenoma were detected incidentally on MRI, and consultation with the department of pediatrics recommended close observation. After treatment with 6mg of risperidone in combination with 300 mg of quetiapine, psychotic symptoms improved enough to be discharged. Since March 25th of 2019, due to manifestation of paralytic ileus from worsening of underlying constipation, all the oral medications were stopped along with NPO for treatment; in addition, IM injection of haloperidol was only allowed for the symptom control. The day before the onset of neuroleptic malignant syndrome, IM injection of 15 mg of haloperidol and 10 mg of lorazepam resulted in vomiting, headache, fever of 39℃, systemic tremor and stiffness, confusion in consciousness, tachycardia and sweating. On April 1st of 2019, with suspicion of neuroleptic malignant syndrome, the patient was transferred to ICU at our institution. Blood work-up performed on day of admission at ICU indicated CPK 2836 IU/L and myoglobulin 337.2 ng/ml, and CPK, after peaking at 4493 IU/L, continuously decreased and was normalized by the 18th day at ICU. Diazepam (IV), dantrolene, domperidone, L-Dopa/benserazideand and cold blanket were applied because the patient continuously screamed due to fever, stiffness, tremor, and psychotic symptoms. Even though confusion improved after 3 days, nausea and vomiting persisted for 8 days. Tremor, stiffness, and fever were stabilized after 3 days. Tachycardia improved after 17 days. Recovery of hematologic abnormalities such as increased CPK and myoglobulin and leukocytosis were followed by stabilization of tremor, stiffness, and high fever on the 18th day. The patient was transferred out of ICU after 18 days, and symptoms were all stabilized after treatment with clozapine. Discussion Evaluation of risk factors of NMS in patients requiring neuroleptics is most critical in order for prompt differentials and early intervention. Known risk factors are 1) male, 2) combination of more than two antipsychotic, 3) histor