Delirium derived from dementia with Lewy bodies in the cancer perioperative period: a case report.

Abstract

Background: Delirium derived from dementia with Lewy bodies (DLB), and the risk of drug hypersensitivity derived from DLB is not well recognized in oncology. To avoid severe side effects caused by antipsychotics, these risks need to be carefully considered by health care providers involved in cancer treatment. The objective of this study is to report the presence of DLB-derived delirium, which is often mixed with ordinary delirium, and its associated hidden risk in cancer treatment.

Case description: A male in his 80s presented with no history of psychiatric disorders. Although he had experienced visual hallucinations such as animals or persons, and the gradual progression of Parkinsonism for several years, he was not undergoing treatment by a psychiatrist. When hospitalized for endoscopy examination, he became agitated with delusions and hallucinations, and was diagnosed with delirium. The examination was postponed. After 2 months, he was diagnosed with DLB, and the delirium he experienced was regarded as a part of DLB. After treatment with donepezil, lemborexant, and yokukansan (a Japanese herbal medicine), his mental status stabilized, and the surgery was conducted safely after drug hypersensitivity with DLB was carefully considered.

Conclusions: In the cancer perioperative period, delirium derived from DLB may occur mixed with ordinary delirium. Oncologists need to be aware of the risk of hidden DLB with delirium and remain updated regarding this topic. In addition, these patients may well be treated with psychotropics that, in principle, do not exacerbate extrapyramidal symptoms, such as donepezil, yokukansan, and lemborexant.