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Hyperpigmentation Probably Related to Haloperidol in a Patient with Neuroacanthocytosis

A 24-year-old male presented with insidious onset progressive abnor-mal involuntary movements of all four limbs for the last two years. Family history for a similar disorder was negative. On examination, he had generalized chorea, “ rubber man ” gait, and feeding dystonia (See Video 1 segment 1). His peripheral blood picture yielded acanthocytes and the patient had absent levels of chorein, as deter-mined by Western blot suggestive of mutations in both copies of the VPS13A gene consistent with a diagnosis of neuroacanthocytosis (See acknowledgment). We prescribed tablets of haloperidol (5 mg three times daily) as he could not afford tablet tetrabenazine due to ﬁ nancial constraints. After 7 days of treatment, he noticed insidious onset gradually progressive generalized hyperpigmentation of skin all over his body. He came for a follow-up after 15 days and on exami-nation, we noticed generalized hyperpigmentation of skin which was more prominent over the face, forehead, and distal extremities (See Video 1 segment 2). We implicated haloperidol in the causation of this hyperpigmentation as this was the only drug the patient was taking during that time. After the stoppage of tablet haloperidol, he was treated with tablet clonazepam daily). His symptoms signi ﬁ cantly improved at a 3-month follow-up (See Video 1 segment 3 ).