Neuroleptic Malignant Syndrome (NMS) Induced by Clozapine at a Very Low Dose

This report describes a case of the clozapine-induced neuroleptic malignant syndrome (NMS) in a 25-year-old woman with schizophrenia. The patient developed NMS symptoms after restarting clozapine following a period of discontinuation. Atypical presentations of NMS, challenges in diagnosis, and the possibility of a dose-dependent relationship are discussed. Key points of the reports are as followed. Clozapine-induced NMS can present atypically, lacking the classic triad of fever, rigidity, and altered mental status. Clinicians should consider a broader range of symptoms when diagnosing NMS, especially with clozapine. The exact threshold for clozapine-induced NMS is unknown, but it may occur even at low doses as 25mg per day. Early diagnosis and intervention are crucial for successful management. The report concludes by highlighting the need for further research to better understand clozapine-induced NMS, including risk factors, dose thresholds, and biomarkers for early diagnosis.