D was brought to the district hospital by his family after developing a high fever, muscle rigidity, and confusion over the past 24 hours. He had been treated with haloperidol for psychosis a week earlier at a local clinic. His family reported that he had become progressively lethargic, had difficulty moving, and was sweating excessively. His symptoms worsened rapidly, with episodes of severe agitation and tremors.

D had a history of schizophrenia, for which he had been inconsistently treated due to limited access to mental health care. His most recent episode of psychosis had led to the initiation of haloperidol therapy, with no prior history of neuroleptic use. There was no history of recent infections, head trauma, or other illnesses.

On arrival, D had a high fever (40.5°C), generalized muscle rigidity, and was confused, barely responding to verbal stimuli. His pulse was rapid (120 bpm), and he exhibited autonomic instability, including fluctuating blood pressure. Laboratory tests revealed elevated creatine kinase (CK), indicating muscle breakdown, and metabolic acidosis.

Neuroleptic Malignant Syndrome (NMS) likely caused by haloperidol therapy.

D was immediately taken off haloperidol, and supportive care was initiated, including aggressive cooling measures, intravenous fluids, and medications to manage muscle rigidity (dantrolene) and agitation (benzodiazepines). His vital signs were closely monitored, and a plan was made for transfer to a tertiary hospital for more advanced care if necessary.

After several days of intensive care and supportive treatment, D’s fever subsided, and his muscle rigidity and confusion gradually improved. A long-term plan was developed for alternative antipsychotic therapy with close monitoring, with his family being educated about the risks of NMS and the importance of follow-up care.