Complex Presentation of Neuroleptic Malignant Syndrome and Autoimmune Encephalitis

This case study discusses a 36-year-old male with a history of schizophrenia who presented with generalised tiredness, feverish sensation, and decreased responsiveness, subsequently diagnosed with overlapping neuroleptic malignant syndrome (NMS) and autoimmune encephalitis.Initial management included intubation, ventilation, external cooling, and withholding antipsychotics.Despite gradual improvement, the patient experienced recurrent fever and neurological deterioration, leading to further investigations.Magnetic resonance imaging (MRI) was normal, but PET-CT suggested rhabdomyolysis/myonecrosis and possible autoimmune encephalitis.The patient received IVIG, rituximab, and antibiotics for a urinary infection.Multidisciplinary collaboration was essential, involving neurologists, psychiatrists, infectious disease specialists, and others to address complications like hypokalaemia, tachycardia, and involuntary movements.This case underscores the importance of a systematic approach and advanced diagnostics in managing complex presentations, highlighting the need for coordinated care and thorough patient and family communication for successful outcomes.