Neuroleptic malignant syndrome: the diagnostic dilemma

Neuroleptic malignant syndrome (NMS) is a life-threatening, often fatal idiosyncratic reaction to neuroleptic or other drug therapies that antagonise the central dopaminergic neurotransmission. The clinical presentation of NMS is very heterogeneous. The lack of specific levels of symptom severity in currently used diagnostic criteria dims the diagnosis of NMS. Therefore differential diagnosis is of priority, because NMS is a diagnosis of exclusion. The aim of this paper is to present a complex clinical picture in a patient that after a differential diagnostic exclusion of other medical conditions and intoxications is diagnosed as NMS. Case reports such as these help raise awareness of this clinical issue.