Neuroleptic malignant syndrome precipitated by chlorpromazine: a case report

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal reaction to dopamine-blocking agents. Although most commonly associated with prolonged or high-dose antipsychotic use, it can also occur after a single therapeutic dose. A 56-year-old Somali man developed acute NMS within hours of receiving a single intramuscular dose of chlorpromazine for agitation, presenting with hyperthermia, severe rigidity, altered mental status, autonomic instability, and markedly elevated creatine kinase levels. Alternative diagnoses were excluded, and prompt discontinuation of chlorpromazine with supportive care and bromocriptine resulted in rapid clinical and biochemical recovery. This case highlights that NMS may occur rapidly following a single lowtherapeutic dose of chlorpromazine. Early recognition and timely management are essential for favorable outcomes. To our knowledge, this is the first reported case of chlorpromazine-induced NMS from Somalia.