Table 1
Clinical features of the two cases in the present report and previously reported cases.
| REFERENCE | AGE (YEARS) /SEX | PD DURATION (YEARS) | MEDICATIONS (MG/DAY) | DURATION OF DYSKINESIA BEFORE ADMISSION (DAYS) | BODY TEMPERATURE (OF) | SIGNS AND SYMPTOMS | LEVEL OF SERUM CREATINE KINASE (IU/L) | DIAGNOSIS | POSSIBLE TRIGGERS | MANAGEMENT | OUTCOME |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Factor and Molho, 2000 | 50/M | 6 | L/C 600/60 Adding pramipexole with up-titration | < 1 | N/A | Generalized dyskinesia, shortness of breath, diaphoresis, and marked dehydration | > 21,000 | Rhab-LID without AKI | Adding pramipexole | Stopped all medications, IV fluid replacement | Improved |
| Gil-Navarro and Grandas, 2010 | 68/F | 12 | L/C/E 750/250/1,000, pramipexole 4, amantadine 200 | 2 | 106.2 | Generalized dyskinesia, drowsiness, fever, tachycardia, visual and auditory hallucination | 1,455 | DHS without AKI | N/A | Stopped pramipexole, adding quetiapine 25 mg/day, IV fluid replacement | Improved and D/C 7 days after admission |
| Lyoo and Lee, 2011 | 74/M | 17 | L/C 3,000/300, L/B CR 400/100 | 9 | 100.8 | Generalized dyskinesia, mild rigidity, good consciousness | 24,651 | DHS with AKI | Increasing dose of levodopa | Stopped all antiparkinsonian medications, IV midazolam 0.4-0.8 ug/min/kg | Improved and D/C 9 days after admission |
| Bektas et al., 2014 | 76/F | 15 | L/C/E 1500/375/2,000 | 3 | Reported normal BT | Generalized dyskinesia, good consciousness | 2,253 | Rhab-LID with AKI | Increasing dose of levodopa | Hemodialysis, lowered levodopa dosage | Died due to severe pneumonia with sepsis |
| Taguchi et al., 2015 | 70/F | 13 | L 600, pramipexole IR 3 then switched to ER 3, selegiline 5 | 7 | 104.5 | Generalized dyskinesia, fever, tachycardia, visual hallucination | >30,000 | DHS with AKI | Switching pramipexole IR to ER formulation | Tapered down of all antiparkinsonian medications | Improved |
| Herreros-Rodriguez and Sánchez-Ferro, 2016 | 76/F | 18 | LED 670.5 | N/A | 104.4 | Dyskinesia, fever, good consciousness | 257 | DHS without AKI | High environmental temperature | Switched to LCIG | Improved |
| Sánchez-Herrera et al., 2016 | 66/F | 16 | LCIG L=1,450, safinamide 100, amantadine 200, ropinirole 8 | 8 | 104.4 | Generalized dyskinesia, fever, confusion, visual hallucination | 7,177 | DHS without AKI | Adding ropinirole, high environmental temperature | Stopped all antiparkinsonian medications, IM clorazepate 50 mg, IV diazepam 10 mg, IV midazolam 10 mg | Improved |
| Baek et al., 2017 | 1st visit; 74/F | 23 | L 375, amantadine 200, pramipexole ER 1.075 | 1 | 104.5 | Generalized dyskinesia, fever, confusion, visual hallucination | 1,023 | DHS with AKI | Fracture of ribs | Stopped pramipexole ER, and amantadine, IV midazolam | Improved and D/C 6 days after admission |
| 2nd visit; 75/F | 24 | L 500, amantadine 200, pramipexole ER 1.075 | 2 | 100.8 | Generalized dyskinesia, fever, confusion, visual hallucination | 661 | DHS with AKI | Fall with trauma to the left flank | Stopped pramipexole ER, reduced levodopa to 300 mg/day, IV fluid replacement | Improved and D/C 9 days after admission | |
| Sarchioto et al., 2018 | Case 1; 80/M | 17 | LCIG L=1500, amantadine 200, pramipexole 1, sertraline 50 | N/A | 107.6 | Generalized dyskinesia, fever, confusion, lethargy | 16,040 | DHS with AKI | Cholecystitis, high environmental temperature | IV fluid replacement, IV ATB, stopped pramipexole, and amantadine, reduced LCIG to 700 mg/day | Died due to multi-organ failure 5 days after admission |
| Case 2; 76/F | 18 | LCIG L=1,200, pramiplexole 1, clozapine 25, venlafaxine 75, zolpidem 10 | < 1 | 105.8 | Generalized dyskinesia, stupor, tachycardia, respiratory distress, dehydration | 2,967 | DHS | Infection, high environmental temperature | N/A | Died within 1 day after admission | |
| Case 3; 79/F | 30 | LCIG L=1,250 | 4 | 103.1 | Generalized dyskinesia, fever, dehydration | 1,967 | DHS with AKI | Infection, high environmental temperature | IV fluid replacement, IV ATB, reduced LCIG to 675 mg/day | Improved and D/C 6 days after admission | |
| Novelli et al., 2019 | 62/M | 34 | STN-DBS, L/C 2,000/200, E 1,600 | 3 hours | 105.3 | Generalized dyskinesia, fever, tachycardia, confusion | 4,891 | DHS | Urinary tract infection, high environmental temperature | IV fluid replacement, IV ATB, Reduced setting of DBS, reduced L/C to 750/75, and E to 1,200 | Improved and D/C 4 days after admission |
| Cases from the present report | Case 1; 64/M | 10 | L 650, E 500, piribedil 150, benzhexol 2 | 2 | 99.5 | Generalized dyskinesia, sweating, good consciousness | 4,246 | Rhabdomyolysis Induced LID | Delayed gastric emptying time | Stopped all medications, IV fluid replacement, intravenous diazepam | Improved and D/C 6 days after admission |
| Case 2; 61/F | 10 | L 875, E 800, ropinirole 4 | 4 | 100.2 | Generalized dyskinesia, fever, dehydration, myalgia, good consciousness | 12,094 | DHS with AKI | Urinary tract infection, increasing dose of ropinirole | Stopped all medications, IV fluid replacement, intravenous diazepam | Improved and D/C 5 days after admission |
[i] D/C, discharge; ER, extennded release; F, female; IR, immediate release; IV, intravenous; LCIG, levodopa-carbidopa intestinal gel; M, male; NA, not available; PD, Parkinson’s disease.