Malignant syndrome triggered by influenza A virus infection in a patient with Parkinson’s disease with improvement after intravenous peramivir treatment

  • Kosuke MatsuzonoEmail author
  • Masamichi Baba
  • Goro Imai
  • Hiroaki Imai
  • Shigeru Fujimoto
Letter to the Editor


Malignant syndrome, also called parkinsonism-hyperpyrexia syndrome, is a rare medical emergency in patients with Parkinson’s disease (PD). The precipitating events that trigger malignant syndrome in patients with PD are anti-parkinsonian drug withdrawal and stress-related factors [1, 2]. Infection is a major cause of malignant syndrome, and fever is considered the trigger [1]. However, the relationship among malignant syndrome, influenza virus infection, and treatment for influenza virus remains unclear. We herein report a case involving a man with PD who developed malignant syndrome secondary to influenza A virus infection but improved after intravenous peramivir treatment without dantrolene.

Case presentation

A 71-year-old man had an 8-year history of Hoehn–Yahr stage ΙΙΙ PD and lived at home with his wife. His gait was slightly unstable, but he was able to walk independently without a cane. His Movement Disorder Society (MDS)-sponsored revision of the Unified...



We appreciate the cooperation of the patient. We also thank Angela Morben, DVM, ELS, from Edanz Group ( for editing a draft of this manuscript.

Authors’ contributions

K.M., M.B., G. I, and H.I. were the attending doctors in the present case. K.M. drafted the manuscript. S.F. conceived the study, participated in its coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical standards

Informed consent was obtained from the patient described in this article.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineImai HospitalTochigiJapan
  2. 2.Division of Neurology, Department of Internal MedicineJichi Medical University School of MedicineTochigiJapan

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