DOI: 10.36347/sasjm.2022.v08i11.004

Pages: 792-797

Introduction: Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, potentially fatal disease that can present with an atypical clinical picture that refers to subthreshold presentations of NMS. The aim of our study is to shed light on the atypical presentations of neuroleptic malignant syndrome by highlighting the different clinical and biological features of this entity that may be underestimated or confused with a differential diagnosis. Materials and Methods: A descriptive study that retrospectively studied the clinical characteristics and laboratory results of patients with a diagnosis of neuroleptic malignant syndrome; the patients were divided into two groups: typical malignant syndrome and atypical NMS. All data were transferred and analyzed using SPSS 13.0 software. Results: The Amisulpride was the most frequently implicated drug (n = 36.6%), most patients were male (21 males versus 9 females). The majority of patients had psychosis, there were no statistically significant differences in terms of age, clinical and laboratory characteristics, but in the atypical NMS group both gender were affected with comparable rates, more than half of the patients in the atypical NMS group had no rigidity with no fever and no disturbance of consciousness and creatine kinase (CK)values lower than those observed in the typical NMS group. The evolution was favorable in the atypical NMS group compared to the typical NMS group in which one death was noted and 5 patients were transferred to intensive care. Conclusion: Neuroleptic malignant syndrome is a fatal complication. Clinicians must be vigilant while carefully assessing the features of NMS in a patient on antipsychotics even in the absence of cardinal signs such as rigidity and fever. Furthermore, the need to adopt a spectrum concept of NMS to challenge the underdiagnosis and misdiagnosis of this fatal entity is of paramount importance.