a 29 old male brought to the ER complaining of sudden onset of fever and confusion , recently was admited for hallucinations and was discharged in stable condition, his temp is 38.6 , Bp=150/100 mmhg, PR=112 /min, RR=24/min,mucus membranes are dry, profuse diaphoresis is present, lungs are clear to auscultation , abdominal muscles are rigid , muscle tone is increased (lead pipe rigidity) is note in all limbs, deep tendon reflexes is 2+, tremor is noted . what is your diagnosis?

I am thinking substance abuse intoxication, methamphetamine, ketamine and these kinda stuff.

youn, sudden fever, confusion, no focal neuro signs, increased heart rate, hypertension, tremor are caused by amphetamine intoxication, it also suppresses thirst for which we have dry mucus membranes. It causes muscle cramps but i dont know about rigidity.

lets keep dancing

and dear Dr Farah, if the patient has received antipsychotic medications in the previous hospital admission for the hallucinations, i would put Neuroleptic Malignant Syndrome as the Dx.

Cheers!

it's definitely neuroleptic malignant syndrome based on clinical features and previous admission for hallucinations.

for amphetamine use, the clinical features wouldn't include fever nor rigidity. the hallucinations in amphetamine use would be of paranoid type and this might lead to accidents because people on amphetamines might think someone is trying to kill them and might react accordingly...

when i read the title of the subject, i thought the case would be about some sort of chorea

thanks farah.

Well done for the Qutaiba brothers it is Neuroleptic Malignant Syndrome . nothing can explain the rigidity but this syndrome.

*i wanted the title to be energetic @ asclepius