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Parkinsonism-hyperpyrexia syndrome — SCE Acute Medicine MCQ

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HardMedicine in the ElderlyParkinsonism-hyperpyrexia syndromeSCE Acute Medicine

An 86-year-old man with Parkinson's disease is admitted with aspiration pneumonia. His rotigotine patch is omitted on admission and he becomes rigid, febrile and confused with CK 1800 IU/L. No new antipsychotic has been given. What is the most likely diagnosis?

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Correct answer: C — Parkinsonism-hyperpyrexia syndrome from dopaminergic withdrawal

Abrupt withdrawal of dopaminergic therapy can cause parkinsonism-hyperpyrexia syndrome with rigidity, fever, autonomic instability and raised CK. NMS is similar but requires dopamine antagonist exposure, which is absent here. Pneumonia may precipitate deterioration but does not explain severe rigidity after omitted therapy. The key ward safety lesson is to prescribe time-critical Parkinson's medication accurately during admissions.

Reference: NICE NG71, Parkinson's UK time-critical medicines guidance, BNF