To the Editor.—
In a recent article by Keyser and Rodinitzky,1 attention was focused on a neuroleptic malignant syndrome in patients with Parkinson's disease. We recently studied an untreated patient with mild parkinsonian features and dysautonomia who, on two occasions, developed a hyperthermic syndrome associated with an elevated serum creatine kinase level.
Report of a case.—
A 73-year-old man with a history of anhydrosis and xerostomia for over 30 years and no neuroleptic or antiparkinsonian drug therapy was admitted with intermittent confusion or somnolence, lying immobilized with severe generalized rigidity and opisthotonus. His temperature was 40.5°C, and his skin was hot, flushed, and dry. Extensive work-up failed to reveal evidence of infection. His creatine kinase concentration was 540 U/L (98% muscular fraction). The hyperthermia was controlled effectively by cooling and fluid replacement, and it resolved after 3 days (Figure). Nine days after admission, the patient developed an afebrile urinary