Neuroleptic Malignant Syndrome Masquerading as Sepsis

Neuroleptic malignant syndrome (NMS) is a rare complication secondary to exposure to a dopamine antagonist or withdrawal of a dopamine agonist.Differential diagnoses of NMS include other conditions associated with increased body temperature such as sepsis, drug withdrawal, thyrotoxicosis, malignant hyperthermia, and serotonin syndrome.Sepsis, as a cause in this setting, has to be ruled out since NMS is a diagnosis of exclusion, which may cause considerable delay.We present a patient who was admitted to the Cardiothoracic Intensive Care Unit after a redo-coronary artery bypass grafting.He was administered two doses of metoclopramide, a dopamine antagonist, for postoperative gastroparesis and as a second-line antiemetic agent.He developed increased body temperature the following day, which did not return to baseline until administration of bromocriptine.The patient was on vasoactive support and invasive ventilation, which impeded the clinical diagnosis of NMS.The only positive features were raised creatine phosphokinase levels and increased body temperature.The patient eventually succumbed to multi-organ failure post-surgery even though NMS was treated.Administration of agents known to potentially cause NMS should always be viewed with suspicion, especially in acute settings where signs and symptoms could be masked.Response to bromocriptine, rise in creatine kinase levels, and persistent increased body temperature may aid in the diagnosis of NMS in a susceptible patient.