06 May 2022
: Case report 
Neuroleptic Malignant Syndrome with Adrenal Insufficiency After BNT162b2 COVID-19 Vaccination in a Man Taking Valproate: A Case Report
Unusual clinical course, Unexpected drug reaction
Tomohito Mizuno1ABCDEF, Riku Takahashi1BCD, Takahiro Kamiyama1BCD, Atsushi Suzuki1D, Masashi Suzuki1ADE*DOI: 10.12659/AJCR.936217
Am J Case Rep 2022; 23:e936217
Table 1. Laboratory data of the patient.
| First hospital day | Second hospital day | |
|---|---|---|
| Creatine kinase (U/L) | 1338 | 3191 |
| Lactate dehydrogenase (U/L) | 311 | 345 |
| Aspartate aminotransferase (U/L) | 89 | 139 |
| Alanine aminotransferase (U/L) | 36 | 50 |
| Alkaline phosphatase (U/L) | 43 | 41 |
| Total bilirubin (mg/dL) | 0.7 | – |
| Blood urea nitrogen (mg/dL) | 45 | 48 |
| Serum creatinine (mg/dL) | 6.15 | 5.68 |
| Estimated GFR (ml/min/1.73 m) | 8.8 | 9.6 |
| Serum sodium (mEq/L) | 137 | 135 |
| Serum potassium (mEq/L) | 4.7 | 3.5 |
| Serum chloride (mEq/L) | 99 | 100 |
| Serum calcium (mg/dL) | 9.7 | – |
| Serum phosphorus (mg/dL) | 2.0 | – |
| Serum albumin (g/dL) | 3.2 | 2.9 |
| C-reactive protein (mg/dL) | 19.7 | 21.8 |
| Antinuclear antibody (titer) | – | 1: 40 |
| MPO-ANCA (U/mL) | – | < 1.0 |
| PR3-ANCA (U/mL) | – | < 1.0 |
| White blood cell (/µL) | 8610 | 6150 |
| Neutrophil (%) | 52.4 | 75.0 |
| Lymphocyte (%) | 27.8 | 9.3 |
| Monocyte (%) | 16.3 | 10.2 |
| Eosinophil (%) | 3.0 | 5.0 |
| Red blood cell (/µL) | 356×10 | 332×10 |
| Hemoglobin (g/dL) | 11.2 | 10.3 |
| Hematocrit (%) | 31.3 | 29.7 |
| Platelet (/µL) | 16.1×10 | 14.1×10 |
| GFR – glomerular filtration rate; MPO-ANCA – myeloperoxidase-anti-neutrophil cytoplasmic antibodies; PR3-ANCA – proteinase-3-anti-neutrophil cytoplasmic antibodies. | ||