Atypical neuroleptic malignant syndrome

Area of Science:

• Neurology
• Psychiatry
• Internal Medicine

Background:

• Schizophrenia management involves antipsychotic medications, which carry risks.
• Medication adjustments in psychiatric patients require careful monitoring for adverse effects.

Observation:

• A 57-year-old male with schizophrenia presented with confusion, autonomic instability, rigidity, and elevated creatine kinase after antipsychotic dose reduction.
• Physicians hesitated to diagnose neuroleptic malignant syndrome (NMS) due to the absence of fever, delaying critical care.
• The patient experienced acute renal failure and transfers between medical and psychiatric wards, highlighting diagnostic and management challenges.

Findings:

• Neuroleptic Malignant Syndrome (NMS) can manifest atypically, without fever, complicating diagnosis.
• Delayed diagnosis and management of NMS can lead to severe complications, including renal failure.
• Effective interdisciplinary collaboration is vital for timely and accurate diagnosis of NMS.

Implications:

• Clinicians must differentiate medical emergencies like NMS from psychiatric presentations.
• Prompt recognition and management of NMS in an appropriate medical setting are essential for patient outcomes.
• Enhanced awareness and proactive diagnostic approaches are needed to address rare, life-threatening neurological disorders in psychiatric patients.