Delayed diagnosis of parkinsonism hyperpyrexia syndrome resulting in death: a case report

A 68-year-old woman with a history of Parkinson disease was admitted for Escherichia coli urinary tract infection and physical deconditioning. She was subsequently found to have a history of rheumatoid arthritis and iatrogenic Cushing syndrome with adrenal insufficiency. The patient developed high fever, fluctuating blood pressure, hypertonia, progressive confusion, and recurrent generalised tonic-clonic seizures. She was kept nil by mouth, and levodopa was withheld for 2 days. Blood test showed elevated creatine kinase level. Diagnosis of parkinsonism hyperpyrexia syndrome was made after consultation with neurologists, and levodopa was resumed. However, her condition did not improve and she later died. This case highlights the precipitating factors of parkinsonism hyperpyrexia syndrome and the importance of early recognition of the disease. Care must be taken in avoiding sudden withdrawal of levodopa in patients with Parkinson disease.