Neuroleptic Malignant Syndrome: Early Diagnosis Saves Lives in Low-Resource Settings

CONTEXT: Neuroleptic malignant syndrome (NMS) is an uncommon but serious adverse event to antipsychotic medications. CASE DETAILS: A 14-year-old Ugandan lady presented with high grade fevers, multiple convulsions, altered mentation and lead-pipe rigidity following an intramuscular injection of zuclopenthixol acetate (as Clopixol-Acuphase(®)). Her labs were significant for elevated aminotransferases and leucocytosis. She had a normal brain CT scan, renal function and cerebrospinal fluid analysis. Discontinuation of Clopixol, administration of bromocriptine 5mg once daily and dantrolene 25mg three times a day and supportive treatment resulted in a complete neurological recovery within 4 weeks of the onset of symptoms. DISCUSSION: Early diagnosis and prompt supportive therapy are required to reduce mortality and morbidity. Early recognition of symptoms and discontinuation of offending agent by health care providers are needed to have recovery even in settings with limited resources.