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Parkinsonism-hyperpyrexia syndrome — SCE Acute Medicine MCQ

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HardMedicine in the elderlyParkinsonism-hyperpyrexia syndromeSCE Acute Medicine

A 68-year-old man with Parkinson's disease is admitted with pneumonia. His usual co-careldopa has been omitted for 36 hours because he is nil by mouth. He is now rigid, febrile and confused with CK 3,400 IU/L. What is the most likely underlying cause?

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Correct answer: A — Parkinsonism-hyperpyrexia syndrome from abrupt dopaminergic withdrawal

Abrupt withdrawal of dopaminergic therapy can cause parkinsonism-hyperpyrexia syndrome, resembling neuroleptic malignant syndrome with rigidity, fever, delirium and raised CK. In acute admissions, time-critical Parkinson's medicines should be maintained using alternative routes or dispersible preparations where needed. Levodopa excess usually causes dyskinesia rather than severe akinetic rigidity.

Reference: NICE NG71; Parkinson's UK Time Critical Medication Guidance