Management of neuroleptic malignant syndrome induced by paliperidone: A case report of multidisciplinary treatment approaches, including apomorphine and electroconvulsive therapy

A 34-year-old female patient with a history of bipolar affective disorder, who had been receiving paliperidone 100 mg monthly and biperiden 3 mg daily for the past two years, was admitted to the emergency department with a three-day history of fever, altered consciousness, dysphagia, mutism, rigidity, inability to walk, inability to speak, and vacant, meaningless stares. It was noted that her last paliperidone injection was administered 12 days before the hospitalization. Vital signs revealed a fever of 38.1°C, mild tachycardia, and normal blood pressure. Laboratory tests indicated leukocytosis and an elevated serum creatine kinase (CK) level of 1098 U/L (normal range: 39-308 U/L), suggesting muscle breakdown. Neurological examination revealed excessive sweating, confusion, rigidity, and dysphagia. A written informed consent was obtained from the patient.