Malignant syndromes: current advances

ABSTRACT

Introduction: Many drugs are known to induce malignant syndromes. The most common malignant syndromes are induced by the use of antipsychotics and anesthetics and the withdrawal of anti-Parkinson drugs. As the clinical manifestations of antipsychotic malignant syndrome, Parkinson’s disease hyperpyrexia syndrome and anesthetic-induced malignant syndrome are very similar, they are easily confused in the clinic.

Areas covered: We reviewed articles published between 1960 and April 2021 describing malignant syndromes. This paper provides a detailed literature review of malignant syndromes and important guidance for the diagnosis and treatment of malignant syndromes to clinicians.

Expert opinion: Although malignant syndromes are rare conditions with a low incidence, these conditions usually progress rapidly and can endanger patients’ lives, meriting attention from clinicians. The typical clinical manifestations of malignant syndromes are hyperpyrexia, muscular rigidity, an altered mental status and increased levels of creatine kinase; however, the pathophysiology, treatment and prognosis of different malignant syndromes are quite different. Prompt diagnosis and treatment may significantly improve the prognosis of patients with malignant syndromes.

KEYWORDS:

• Malignant syndrome
• hyperthermia
• antipsychotics
• anesthetic
• anti-parkinson drug
• diagnosis
• therapy

Article highlights

• The most common malignant syndromes are induced by the use of antipsychotics and anesthetics and the withdrawal of anti-Parkinson drugs.

• The typical clinical manifestations of malignant syndromes are an elevated body temperature, muscular rigidity, altered mental status and increased serum CK levels.

• Common complications of malignant syndromes include rhabdomyolysis, acute kidney injury, respiratory failure, aspiration pneumonia, deep vein thrombosis or pulmonary embolism, and DIC.

• Malignant syndromes are usually based on a clinical diagnosis and should be considered whenever the typical clinical manifestations of malignant syndromes occur within the period of using of antipsychotics and anesthetics and the withdrawal of anti-Parkinson drugs.

• Once malignant syndromes are suspected, an immediate adjustment of pathogenic drugs is the most important approach, and active support treatment should be initiated; alternative drugs include dantrolene, bromocriptine and benzodiazepines.

• Malignant syndromes are critical illnesses with a rapid progression; if they are not diagnosed and treated in a timely manner, fatal hyperthermia and multiorgan failure can occur.

Authors’ contributions

MT and JL conceived the article and wrote the manuscript. XT and XW reviewed and edited the manuscript. All authors read and approved the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work was funded by the National Natural Science Foundation of China (grant number 82001378 to Xin Tian).