Neuroleptic Malignant Syndrome Following Brexpiprazole Initiation in a Treatment-Resistant Schizophrenia Patient With Influenza A: A Case Report

We present a case of a 30-year-old male with a 15-year history of treatment-resistant schizophrenia who developed neuroleptic malignant syndrome (NMS) after the initiation of brexpiprazole in the setting of serology-confirmed influenza A infection. The patient was also receiving maintenance electroconvulsive therapy (ECT) and was undergoing cross-titration of antipsychotics when he developed fever, cough, shortness of breath, tremors, and rigidity. He tested positive for influenza A, and there were no records of any regular influenza vaccination. This case underscores the need for caution in the initiation of antipsychotics, including brexpiprazole, in this group of patients and the potential role of systemic infections in precipitating NMS. Early recognition and prompt intervention are crucial in preventing morbidity and mortality. Furthermore, this case highlights the importance of regular influenza vaccination, particularly in individuals with serious mental illness and on long-term antipsychotic therapy.