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Neuroleptic malignant syndrome — SCE Acute Medicine MCQ

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ModerateOtherNeuroleptic malignant syndromeSCE Acute Medicine

A 51-year-old man with schizophrenia is brought in during a heatwave with confusion and rigidity. He started depot haloperidol five days ago. Temperature is 40.2°C, pulse 132/min, BP 168/94 mmHg and CK is 8,600 IU/L. He has lead-pipe rigidity and fluctuating consciousness. What is the most likely diagnosis?

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Correct answer: E — Neuroleptic malignant syndrome

Hyperthermia, severe rigidity, autonomic instability and markedly raised CK after dopamine antagonist exposure indicate neuroleptic malignant syndrome. Serotonin syndrome typically has clonus, hyperreflexia and serotonergic exposure. Acute dystonia does not produce profound fever, rhabdomyolysis and encephalopathy.

Reference: BNF Antipsychotics; NICE CKS Antipsychotic adverse effects