Background: The parkinsonism hyperpyrexia syndrome (PHS) is a rare but potentially fatal disorder. We reported an advanced Parkinson's disease (PD) patient who was initially diagnosed with fever of unknown origin and finally with PHS, together with a review of the literature. Case Report: A 67-year-old woman with PD presented with high-grade fever accompanied by altered consciousness and rigidity. Prior to the symptom onset, she had a couple week's history of poor feeding due to her dental problem. However, she had regularly taken her anti-Parkinsonian medication even during that period, which hampered early recognition of PHS at the emergency room. Her anti-Parkinsonian medication was withheld for more than 30 hours during her stay in our emergency room and extensive diagnostic work-up to identify the fever focus. Her neurologic symptoms deteriorated with concurrent acute hepatic failure and disseminated intravascular coagulopathy. Levodopa treatment was resumed on correction of underlying medical conditions. The patient recovered dramatically with normalization of laboratory tests. Conclusion: This case indicated that PHS could occur in patients without prior history of withdrawal of antiparkinsonian medication, possibly due to poor absorption or poor feeding conditions.

Background: Delayed encephalopathy after carbon monoxide (CO) poisoning is a severe neurologic impairment that occurs after apparent recovery from the acute event. These patients rarely remain neurologically independent, and no effective treatment has yet been validated. Case Report: Two patients had survived acute CO intoxication without neurologic sequelae. Three weeks after each of the two patients recovered, the patients gradually developed cognitive impairment, urinary incontinence, akinetic mutism and parkinsonism. After the administration of high dose prednisolone, the treatment response was prompt within two weeks, and the patients have recovered with mild cognitive impairment within one year. Conclusion: High dose prednisolone can be used for treatment of delayed encephalopathy after CO poisoning.