A case of atypical neuroleptic malignant syndrome following discontinuation of many different neuroleptics and antidepressant agents is described. A 33-year-old woman with a 6-year history of depression and alcoholism had been treated with daily oral doses of 2mg of haloperidol, 75mg of clomipramine, 150mg of sulpiride, 150mg of trazodone, 3mg of etizolam, 3mg of biperidene, and 0.5g of disulfiram. She was admitted to a local hospital because of agitation and confusion. The patient refused all medication and her ingestion had markedly decreased. Six days after discontinuing her medication, she developed hypotension and was transferred to our institution. When brought to our emergency room, she was in shock with cold sweats, tachycardia, and consciousness disturbance. She became pyrexic, and 3 days after admission developed systemic tremor and oral dyskinesia. Her serum creatine phosphokinase levels gradually increased in spite of the improvement of her hemodynamic state. A diagnosis of atypical neuroleptic malignant syndrome was made, and treatment with dantrolene and bromocriptine was instituted. Her symptoms gradually subsided. This case suggests that development of neuroleptic malignant syndrome should be borne in mind whenever antipsychotic drugs are abruptly discontinued.
