A 17-year-old patient with bipolar disorder, borderline personality disorder and a history of marijuana, cocaine, ecstasy and heroin abuse.
After four days of being discharged from a psychiatric clinic in Santiago, where she was treated with clozapine, valproic acid, lithium carbonate and lorazepam for two months, she began a clinical picture of intractable fever,
On physical examination, fever, tachycardia, normotension, rigidity mainly of the axial skeleton, and great psychomotor agitation were observed.
Blood count at admission showed 17,000 leukocytes/mm3 with 14% bacilliforms, normal platelets, ESR of 31, CRP of 19.8 mg/dl, CK of 920 mg/dl were taken with normal lung aspiration.
Since the patient was receiving clozapine, she was interpreted as a malignant syndrome, the drug was discontinued and treatment with bromocriptine was started.
A surface echocardiogram ruled out endocarditis and an abdominal computed axial tomography (CAT) revealed polyserositis due to ascites and pleural effusion, which, given the small amount, were not punctured.
ANA, ANCA, anti-DNA, negative anti-ENA and normal complementemia were detected in the remainder.
One week after the operation, the patient was better conscious, but she remained febrile, suffered from aggregation with left-sided leukocytes deviation of greater than 1.1 UL/mm3, and had abnormal liver tests with SGOT of 627.
In this context, antibiotics and valproic acid were discontinued, remaining only with lorazepam.
The patient remained in these conditions, with decreasing inflammatory parameters and 12 days after admission the fever ceased.
At discharge, the patient had no fever and very good mood, normochromic normocytic non-regenerative anemia, leukocytosis, with no normal left shift, liver disease greater than 4,000/mm3, normal CK and tests
At the 10-day medical follow-up, the patient was in good general condition, depressed, afflicted with normal CK and a complete blood count with increased hematocrit after two weeks, but with relative lymphocytes.
