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Lim JHB, Robinson B, Savige J. Delayed-Onset olanzapine-induced rhabdomyolysis. BMJ Case Rep 2023; 16:e254377. [PMID: 36898712 PMCID: PMC10008316 DOI: 10.1136/bcr-2022-254377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Olanzapine is a commonly used and effective second-generation antipsychotic agent used for the control of paranoia and agitation in schizophrenia and bipolar disorder as well as in the behavioural and psychological symptoms of dementia. Serious side effects of treatment are uncommon but spontaneous rhabdomyolysis represents a rare complication. We describe here a patient treated with a stable dose of olanzapine for more than 8 years who developed acute severe rhabdomyolysis without an identifiable trigger and without features suggestive of neuroleptic malignant syndrome. The rhabdomyolysis was atypical in its delayed onset and severity with a creatine kinase level of 345 125 U/L, the highest level reported in the available literature. We also describe the clinical manifestations of delayed-onset olanzapine-induced rhabdomyolysis and its differentiation from neuroleptic malignancy syndrome, and we highlight key aspects of management to prevent or minimise further complications such as acute kidney injury.
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Affiliation(s)
- Jun Hua Bowen Lim
- General Medicine, The Northern Hospital, Epping, Victoria, Australia
| | - Billy Robinson
- General Medicine, The Northern Hospital, Epping, Victoria, Australia
| | - Judith Savige
- General Medicine, The Northern Hospital, Epping, Victoria, Australia
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Shi L, Yu G, Zhao L, Wen Z, Li Y, Kan B, Jian X. Methemoglobinemia and Delayed Encephalopathy After 5-Bromo-2-Nitropyridine Poisoning: A Rare Case Report. Front Public Health 2022; 10:942003. [PMID: 35875039 PMCID: PMC9300930 DOI: 10.3389/fpubh.2022.942003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
5-bromo-2-nitropyridine, an intermediate in the synthesis of pharmaceutical and pesticide products, is toxic to the human body. However, 5-bromo-2-nitropyridine poisoning has not been previously reported. Here, we report the case of a 40-year-old man who suffered skin and respiratory tract exposure to leaked 5-Bromo-2-nitropyridine at work. After exposure, the patient rapidly developed dizziness, fatigue, nausea, vomiting, chest distress, diffuse cyanosis, and coma. Methemoglobinemia, hemolytic anemia, rhabdomyolysis, and acute renal failure were observed after admission. He improved markedly after treatment, but delayed encephalopathy was confirmed 82 days after the exposure. This case highlights that 5-bromo-2-nitropyridine can be absorbed through the skin and respiratory tract, resulting in methemoglobinemia and delayed encephalopathy.
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Affiliation(s)
- Longke Shi
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guangcai Yu
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liwen Zhao
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zixin Wen
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yaqian Li
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Baotian Kan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Baotian Kan
| | - Xiangdong Jian
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Xiangdong Jian
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