Three different diagnoses of similar presentations with fever, confusion and rigidity

Abstract

Patients presenting with acute muscular rigidity, fever and confusion is a management challenge in medical practice. It could be a potentially lethal case with poor prognosis. The authors of this article highlight the importance of appropriate assessment of patients to arrive at a correct diagnosis. Clinicians need to be mindful of subtle differences between differential diagnoses. Diagnostic guidelines and criteria assist in differentiating conditions. Management and outcome depends largely on the aetiology of the manifestations. The three cases reported in this paper presented with the symptom triad of muscular rigidity, fever and confusion. However, the causative conditions were different from one case to the other. Heat stroke, serotonin syndrome and neuroleptic malignant syndrome (NMS) were the diagnoses arrived at. Two patients recovered completely, while the other patient succumbed.

Keywords

• opisthotonus, rigidity, neck stiffness, antidepressants, antipyretics, babinski sign, serotonin, serotonin syndrome, neuroleptic malignant syndrome