Hyperthermia in a Teenager: Is it Just a Heat Stroke?

An adolescent male with obesity and autism spectrum disorder presented to the emergency department with acute confusion, chills, muscle rigidity, and severe hyperthermia (tympanic temperature 41.9ºC) after physical exertion in extreme heat. His regular medication included antipsychotics. Laboratory evaluation showed multiorgan dysfunction, supporting a diagnosis of heat stroke with concurrent neuroleptic malignant syndrome. Prompt resuscitation and external cooling were initiated, and the patient was admitted to the pediatric intensive care unit. Management included discontinuation of antipsychotics, dantrolene and bromocriptine, active temperature control using Criticool®, benzodiazepines, and aggressive intravenous fluid therapy. The patient improved gradually and was discharged after four days in intensive care and 14 days in the ward, on aripiprazole and clonidine. This case highlights the diagnostic and therapeutic challenges posed by severe hyperthermia with overlapping features of heat stroke and neuroleptic malignant syndrome.