Understanding Neuroleptic Malignant Syndrome: Lessons from a Near-Miss Case

Neuroleptic malignant syndrome (NMS) is rare and fatal. Unwanted complications can be prevented by early recognition and discontinuation of the offending medications, followed by aggressive treatment. We highlighted a case of a young gentleman with underlying schizophrenia, presented with altered mental state and hyperthermia after introduction of olanzapine. He developed NMS complicated by severe rhabdomyolysis and acute kidney injury. Although the patient had several findings suggestive of NMS, the diagnosis was not made promptly resulting in a delay in treatment. This may be due to the rarity of NMS, its resemblance to other causes of autonomic instability, the general knowledge that atypical antipsychotics are safer and unavailability of a gold standard diagnostic test for NMS. Using a systematic approach and existing criteria as a guide, treating doctors could be able to detect this disease early on.