Parkinsonism Hyperpyrexia Syndrome Mimicking Fever of Unknown Origin in Advanced Parkinson’s Disease Patient

Abstract

Background: The parkinsonism hyperpyrexia syndrome (PHS) is a rare but potentially fatal disorder. We reported an advanced Parkinson’s disease (PD) patient who was initially diagnosed with fever of unknown origin and finally with PHS, together with a review of the literature. Case Report: A 67-year-old woman with PD presented with high-grade fever accompanied by altered consciousness and rigidity. Prior to the symptom onset, she had a couple week’s history of poor feeding due to her dental problem. However, she had regularly taken her anti-Parkinsonian medication even during that period, which hampered early recognition of PHS at the emergency room. Her anti-Parkinsonian medication was withheld for more than 30 hours during her stay in our emergency room and extensive diagnostic work-up to identify the fever focus. Her neurologic symptoms deteriorated with concurrent acute hepatic failure and disseminated intravascular coagulopathy. Levodopa treatment was resumed on correction of underlying medical conditions. The patient recovered dramatically with normalization of laboratory tests. Conclusion: This case indicated that PHS could occur in patients without prior history of withdrawal of antiparkinsonian medication, possibly due to poor absorption or poor feeding conditions.

Keywords

• Parkinson disease
• Malignant hyperpyrexia
• Neuroleptics