Atypical Neuroleptic Malignant Syndrome in a COVID-19 Intensive Care Unit

Area of Science:

• Neurology
• Pharmacology
• Infectious Diseases

Background:

• Neuroleptic malignant syndrome (NMS) is a critical neurologic emergency linked to antipsychotic use, typically high-potency agents.
• Atypical NMS (ANMS) presentations associated with lower-potency, second-generation antipsychotics are less understood.
• Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) pneumonia complicates patient management due to incomplete pathogenetic understanding.

Observation:

• A case of probable ANMS is presented in a patient admitted for SARS-CoV2 pneumonia.
• The patient developed symptoms suggestive of ANMS during treatment for COVID-19.
• This case highlights a potential interaction between COVID-19 and antipsychotic medication effects.

Findings:

• The patient exhibited symptoms consistent with ANMS, challenging typical diagnostic criteria.
• The concurrent SARS-CoV2 infection presented a complex clinical scenario.
• The case suggests ANMS can manifest even with atypical antipsychotic agents.

Implications:

• Critical care clinicians must maintain a broad differential diagnosis for complex clinical presentations.
• Attributing all symptoms solely to COVID-19 may lead to missed diagnoses like ANMS.
• This case underscores the importance of considering medication side effects in critically ill patients, especially during pandemics.