A case of lethal neuroleptic malignant syndrome (NMS) occurring after surgery is reported. The patient was a 68-year-old man with schizophrenia who visited us for treatment of a cheek defect resulting from surgery for carcinoma of the maxilla. Speech and swallowing functions had been restored with the use of a denture, but there was leakage of food to the defect. Reconstruction was performed with a forehead flap, with the patient under general anesthesia. Five days after the operation, he began to have a high fever with sweating, hypotension, tachycardia, muscle rigidity, and involuntary movement accompanied by an increase in the serum level of creatinine phosphokinase. The patient was given a diagnosis of NMS. He died of renal failure. Care should be taken to avoid postoperative development of NMS in psychiatric patients.
