A Neuroleptic Malignant Syndrome Without Rigidity

Area of Science:

• Neurology
• Pharmacology
• Toxicology

Background:

• Neuroleptic malignant syndrome (NMS) is a rare, life-threatening idiosyncratic reaction to neuroleptic medications.
• NMS is characterized by hyperthermia, autonomic dysfunction, altered consciousness, and muscle rigidity.
• While risk factors are known, the exact etiology of NMS remains unclear.

Purpose of the Study:

• To report a unique case of NMS that developed rapidly following multiple antipsychotic medication use.
• To highlight an atypical NMS presentation in the absence of muscle rigidity.
• To emphasize the importance of early diagnosis and prompt treatment in reducing NMS morbidity and mortality.

Main Methods:

• Case report detailing a patient's clinical presentation and treatment course.
• Review of literature on NMS, focusing on atypical presentations and risk factors.
• Analysis of the patient's response to the interruption of neuroleptic agents and subsequent management.

Main Results:

• The patient developed NMS symptoms including altered consciousness and high fever shortly after initiating multiple antipsychotics.
• Notably, the patient did not exhibit the characteristic muscle rigidity typically associated with NMS.
• Early discontinuation of neuroleptic medication and aggressive supportive care led to patient improvement.

Conclusions:

• NMS can manifest with atypical symptoms, such as the absence of rigidity, particularly with polypharmacy.
• Prompt recognition and management are crucial for favorable outcomes in NMS cases.
• This case underscores the need for vigilance in diagnosing NMS, even in the presence of non-classic clinical features.