A Case of Neuroleptic Malignant Syndrome in a ProfoundlyIntellectually Disabled Patient with Successful Reintroduction ofAntipsychotic Therapy with Quetiapine

Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomicinstability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychoticmedications; though, other neuroleptics have been implicated as well. NMS can be fatal with estimated mortality rates as high as20%. Patients experiencing certain severecomplications, includingrenal failure, havebeen associatedwith mortality as high as 50%,stressing the need for early recognition and treatment. Here we present the case of a 54-year-old male that initially presented withsymptoms suspicious for sepsis, but who eventually developed a clinical picture consistent with NMS. We describe the diagnosticand treatment process leading to symptom remission. We then discuss our decision to reintroduce an atypical antipsychoticagent, quetiapine. This case illustrates the importance of early recognition of the signs and symptoms of NMS and the need toinitiate treatment promptly in order to prevent complications, including death. This case also highlights the decision to resumeantipsychotic pharmacotherapy after adequate resolution of NMS, demonstrating that it can be done so safely if started at lowdoses coupled with intensive monitoring of the patient