Neuroleptic malignant syndrome

Abstract

We report 37-year-old man admitted to the psychiatric ward with acute depression. Antidepressive medications were initiated including: promethazine hydrochloride, hydroxyzine hydrochloride, lorazepam and haloperidol. In an attempt to control his depression, doctors increased the dose of haloperidol. Five days later he developed fever, cough, confusion and he was unable to eat. Accordingly, he was transferred to the medical ward for further assessment. On examination he was febrile, confused, there was neck stiffness and generalized rigidity with flexor planters. Both serum myoglobin and creatine kinase level were elevated. The urine myoglobin test result was positive. He was diagnosed with neuroleptic malignant syndrome. Dantrolene was started for 3 days, followed by bromocriptine. The clinical syndrome resolved over the next couple of days.