A clinical case of neuroleptic malignant syndrome against the background of oneiroid schizophrenia in a patient who had a new coronavirus infection

The relevance is determined by the wide spread of a new coronavirus infection. The impact of this infection on the course of other diseases is still being studied. The issue of differential diagnosis between neuroleptic malignant syndrome and febrile schizophrenia remains very important for practical activities.

Objective: to analyze a clinical case of neuroleptic malignant syndrome on the background of febrile schizophrenia in a patient who had previously experienced COVID-19.

Materials and methods. Clinical-archival and clinical-catamnestic research methods were used. According to the case history, a patient is presented who underwent a new coronavirus infection, which developed neuroleptic malignant syndrome against the background of febrile schizophrenia. Presented follow-up after 12 months.

Results and their analysis. The manifestation of a mental disorder in this clinical case occurred against the background of an exacerbation of a herpetic viral infection. Against the background of a pronounced pain syndrome, the first symptoms began to appear - severe anxiety, reduced mood, decreased appetite, hypochondria. Further, the stages of schizoaffective disorder developed sequentially, starting with “pure” affective disorders, then with the addition of psychotic symptoms in the form of delusional ideas, and later on, oneiroid-catatonic disorders. The complexity of this clinical case lies in the fact that after the patient had a new coronavirus infection (with 3% lung damage on CT), the clinical picture worsened significantly and symptoms of neuroleptic malignant syndrome appeared. The somatic condition was also aggravated by the subsequent addition of pseudomembranous colitis, as a complication of a new coronavirus infection. The duration of the psychosis was about six months, and despite the extremely severe somatic condition, active treatment (plasmapheresis, hemosorption, drug sedation), the “break” of acute psychosis did not occur. In the future, psychosis stopped on its own, without any treatment. The patient fully recovered mental and somatic functions, despite unfavorable data before discharge from the somatic hospital (ongoing psychosis, signs of atrophy on magnetic resonance imaging).

Conclusion. Malignant neuroleptic syndrome is a life-threatening condition and requires urgent resuscitation. The ability to make a timely differential diagnosis between neuroleptic malignant syndrome and a febrile seizure determines the set of applied therapeutic measures. The presence of a symptom of brain atrophy according to magnetic resonance imaging in this clinical case is an accidental diagnostic finding and can be regarded as an artifact. In addition, the question of the impact of a new coronavirus infection on the course of a malignant neuroleptic syndrome and an oneiroid episode of acute psychosis remains unresolved and requires further research.

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