OBJECTIVE: To inform clinicians of the potential for severe and persistent @entity2117 with the long-term use of @entity2645 . CASE SUMMARY: A 65-year-old white male veteran with a history of paranoid @entity161 was referred to the psychiatry service by a dentist who thought that the @entity1 was both cyanotic and @entity716 . The history and biopsy results indicated the possibility of @entity2645 -associated @entity2117 , only the second reported case in a male @entity1 . The presentation was complex, with a history of neuroleptic exposure and multiple signs of @entity304 . A brain single photon-emission computed tomography scan @entity75 and bilateral caudate hypermetabolism, which normalized 14 months later. Despite discontinuation of @entity2645 , the @entity1 continued to appear cyanotic, leading to worsening social isolation. He became known as "the @entity1 with the purple face." On his rare ventures outside the home, he was embarrassed by sporadic calls to 911 by @entity1 fearing he was ill. DISCUSSION: Although @entity2117 secondary to the use of @entity11922 has been reported frequently, it is much less common with @entity2645 , and is very rare in males. Failure to recognize this adverse reaction led to continuing treatment with @entity2645 and to an apparently irreversible condition. The brain imaging findings have no link with the hyperpigmenting process, but raise questions about neuroleptic-induced metabolic changes in the brain. CONCLUSIONS: Clinicians need to be aware of rare adverse reactions such as @entity2117 , and be prepared to take appropriate and early action to prevent such reactions from becoming irreversible.

@entity2645 -associated XXXX .

@entity1 :: ('9606', 'Species') :: ['patient', 'persons', 'man'] @entity304 :: ('MESH:D010302', 'Disease') :: ['parkinsonism'] @entity11922 :: ('MESH:D010640', 'Chemical') :: ['phenothiazines'] @entity75 :: ('MESH:D001927', 'Disease') :: ['demonstrated frontal lobe hypermetabolism'] @entity2117 :: ('MESH:D017495', 'Disease') :: ['facial hyperpigmentation', 'hyperpigmentation'] @entity161 :: ('MESH:D012559', 'Disease') :: ['schizophrenia'] @entity2645 :: ('MESH:D007099', 'Chemical') :: ['imipramine'] @entity716 :: ('MESH:D011605', 'Disease') :: ['psychotic']
@entity2117 :: (MESH:D017495,Disease) :: ['hyperpigmentation']
