Abstract
A 42-year old-man was found lying in his bed having seizures. Later he became unconscious and hypotonic developing mydriasis as well as rigidity. The body core temperature (rectal temperature) was above 42 °C. Blood pH was decreased during treatment, and his general condition deteriorated. The patient developed gasping respiration, ventricular fibrillation, and died. During autopsy and histological investigation cerebral and pulmonary edema were noted together with general congestion of the internal organs. Further observations included contraction bands of myocytes, a contracted spleen, fibrosis of the liver, and gall stones. Toxicological analyses of peripheral blood revealed the following results: amisulpride 4.65 mg/l, biperiden 0.12 mg/l, imipramine 0.33 mg/l, and desipramine 0.68 mg/l. An amisulpride-induced neuroleptic malignant syndrome was therefore diagnosed as the patho-physiological mechanism leading to death.
This is a preview of subscription content, log in via an institution to check access.
References
Trollor JN, Chen X, Sachdev PS. Neuroleptic malignant syndrome associated with atypical antipsychotic drugs. CNS Drugs. 2009;23:477–92.
Guzofski S, Peralta R. Neuroleptic malignant syndrome, with attention to its occurrence with atypical antipsychotic medication: a review. Jeff J Psych. 2006;20(1):54–61.
Addonizio G, Susman VL, Roth SD. Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients. Am J Psychiatry. 1986;143:1587–90.
American Psychiatric Association. Diagnostic and statistical manual. 4th ed. (text revision). Arlington, VA: American Psychiatric Publishing; 2000.
Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry. 1985;142:1137–45.
Musshoff F, Kröner L, Padosch SA, Madea B. Fatal intoxication with amisulpride and presentation of organ distribution. Arch Kriminol. 2005;215:158–63.
Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A. Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics. Crit Care. 2012;16(4):R136.
Tracqui A, Mutter-Schmidt C, Kintz P, Berton C, Mangin P. Amisulpride poisoning: a report on two cases. Hum Exp Toxicol. 1995;14:294–8.
Isbister GK, Murray L, John S, Hackett LP, Haider T, O’Mullane P, Gosselin S, Daly F. Amisulpride deliberate self-poisoning causing severe cardiac toxicity including QT prolongation and torsades de pointes. Med J Aust. 2006;184:354–6.
Lynch MJ, Woods J, George N, Gerostamoulos D. Fatality due to amisulpride toxicity: a case report. Med Sci Law. 2008;48:173–7.
Curran MP, Perry CM. Amisulpride: a review of its use in the management of schizophrenia. Drugs. 2001;61:2123–50.
Rosenzweig P, Canal M, Patat A, Bergougnan L, Zieleniuk I, Bianchetti G. A review of the pharmacokinetics, tolerability and pharmacodynamics of amisulpride in healthy volunteers. Hum Psychopharmacol. 2002;17:1–13.
Dorne R, Pommier C, Manchon M, Berny C. Intoxication with amisulpride (Solian): a case with toxicologic documentations. Therapie. 2000;55:325–8.
Bottlender R, Jager M, Hofschuster E, Dobmeier P, Moller HJ. Neuroleptic malignant syndrome due to atypical neuroleptics: three episodes in one patient. Pharmacopsychiatry. 2002;35:119–21.
Atbasoglu EC, Ozguven HD, Can Saka M, Goker C. Rhabdomyolysis and coma associated with amisulpride: a probable atypical presentation of neuroleptic malignant syndrome. J Clin Psychiatry. 2004;65(12):1724–5.
Abay E, Kose R. Amisulpride-induced neuroleptic malignant syndrome. J Neuropsychiatry Clin Neurosci. 2007;19:488–9.
Harter C, Obier C, Druschky KF, Eikelmann B. Malignant neuroleptic syndrome associated with amisulpride. Nervenarzt. 2008;79:86–9.
Peritogiannis V, Tsouli S, Pappas D, Mavreas V, Konitsiotis S. Neuroleptic malignant syndrome due to amisulpride in a patient with solvent-induced chronic toxic encephalopathy. Clin Neuropharmacol. 2007;30:245–6.
Tu MC, Hsiao CC. Amisulpride and neuroleptic malignant syndrome. Chang Gung Med J. 2011;34:536–40.
Pope HG Jr, Keck PE Jr, McElroy SL. Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. Am J Psychiatry. 1986;143:1227–33.
Adityanjee PA. The spectrum concept and prevalence of neuroleptic malignant syndrome. Am J Psychiatry. 1988;145(8):1041.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Musshoff, F., Doberentz, E. & Madea, B. Lethal neuroleptic malignant syndrome due to amisulpride. Forensic Sci Med Pathol 9, 218–220 (2013). https://doi.org/10.1007/s12024-013-9410-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12024-013-9410-1