Neuroleptic malignant syndrome. Diagnostic and therapeutic dilemmas in a general hospital setting

Neuroleptic malignant syndrome (NMS) is a rare life-threatening condition, usually induced by typical and atypical antipsychotics. A middle-aged woman with bipolar disorder and acute back pain due to multiple falls was admitted to the trauma ward of a general hospital. After 3 days, she suddenly developed signs and symptoms of NMS possibly caused by PRN injectable haloperidol, although the additional role of olanzapine could not be ruled out. A 3-day delayed diagnosis of NMS led to serious complications, which could be prevented by its prompt management contingent on its early diagnosis, even in the absence of certain diagnostic criteria. Although she improved substantially with treatment interventions and continued to have dialysis, she died later due to renal complications. The PRN administration of antipsychotic medications needs to be avoided among such psychiatric patients admitted to general hospitals.