Recurrent hypothermia associated with atypical antipsychotics: a diagnostic challenge in a medically complex patient

Antipsychotic-associated hypothermia is a rare but potentially life-threatening adverse effect that remains underrecognized in clinical practice. This case adds evidence of recurrent hypothermia associated with two different atypical antipsychotics in a medically complex patient with multiple predisposing factors for thermoregulatory dysfunction. It also raises the possibility of a bidirectional interaction between hypothermia and acute kidney injury (AKI). We report the case of a 55-year-old woman with tuberous sclerosis, epilepsy, intellectual disability, and chronic kidney disease who developed recurrent episodes of hypothermia in temporal association with risperidone and subsequently olanzapine, with several episodes also accompanied by bradycardia, hypotension, and AKI. Extensive evaluation excluded common causes of hypothermia, including infection, endocrine dysfunction, hypoglycemia, and structural hypothalamic lesions. Recurrent episodes with a consistent clinical pattern resolved following substitution of atypical antipsychotics with haloperidol, supporting a probable drug-induced etiology. No further episodes of hypothermia, bradycardia, hypotension, or AKI occurred during two years of follow-up. Antipsychotic-associated hypothermia requires a high index of clinical suspicion, as diagnosis can be challenging in medically complex patients. This report highlights the importance of recognizing this rare adverse effect and ensuring careful monitoring and timely adjustment of psychotropic treatment. The temporal association with AKI also raises the possibility of a bidirectional interaction, although the underlying mechanisms remain incompletely understood.