title: Neuroleptic malignant syndrome presenting without fever: case report and review of the literature.
abstract: The case of a patient with neuroleptic malignant syndrome (NMS) and delayed fever is presented. The patient was on lithium and trilafon before presentation to the emergency department with altered sensorium, rigidity, drooling, and tachycardia. The patient remained afebrile for 9 hours in the emergency department. He responded to treatment involving discontinuation of neuroleptics and bromocriptine. Typically NMS presents with a tetrad of fever, rigidity, altered sensorium, and autonomic dysfunction. This case is an example of NMS with delayed fever. A review of the literature on neuroleptic malignant syndrome is also presented.
authors.affiliation: Department of Emergency Medicine, University of California, San Diego 92103-8676.
authors.forename: R
authors.initials: R
authors.lastname: Lev
authors.forename: R F
authors.initials: RF
authors.lastname: Clark
mesh_terms: D000328:Adult; D001971:Bromocriptine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003620:Dantrolene / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005334:Fever / Q000503:physiopathology; D006801:Humans; D008094:Lithium / Q000009:adverse effects*; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010546:Perphenazine / Q000009:adverse effects*; D011618:Psychotic Disorders / Q000188:drug therapy
chemical_list: D001971:Bromocriptine; D008094:Lithium; D003620:Dantrolene; D010546:Perphenazine