Abstract
Neuroleptic malignant syndrome can present without fever
Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic adverse reaction to antipsychotic drugs. A fast recognition of NMS is vital to prevent a fatal outcome.
In this article, the case of a 15-year-old boy with psychosis presenting with motor symptoms like tremor and akathisia while on olanzapine is discussed. Due to persistent psychotic symptoms and motoric side effects under olanzapine, the therapy was switched to aripiprazole. This switch resulted in a dramatic worsening of the symptoms and a sudden decrease in global functioning. Psychosis with catatonia was diagnosed and lorazepam was started, with a moderate effect. After several days, lower back pain, chest pain, excessive sweating and rigidity emerged. A blood sample showed extremely high serum creatine kinases. The catatonic state had evolved to NMS during the switch to antipsychotics. The absence of hyperthermia delayed the diagnosis because of the misleading idea that NMS is always associated with an increased body temperature.