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Neuroleptic malignant syndrome — ABEM Board MCQ

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HardPsychiatric emergenciesNeuroleptic malignant syndromeABEM Board

A 44-year-old man with schizophrenia arrives from a group home with fever and rigidity after haloperidol dose increase. Triage acuity is ESI 1; T 104.4 F, BP 172/98 mm Hg, HR 132/min. He is confused with lead-pipe rigidity. CK is 18,000 U/L. Which of the following is the most likely diagnosis?

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Correct answer: C — Neuroleptic malignant syndrome

Fever, altered mental status, autonomic instability, lead-pipe rigidity, and high CK after dopamine antagonist exposure indicate NMS.

Reference: ACEP toxicology/psychiatric emergency guidance