Recurrent Unexplained Fever and Suspected Promazine Toxicity: Why Probable Neuroleptic Malignant Syndrome Was Left Undiagnosed in a Healthcare Worker
Year: 2026
Type: article
Study design: Case Report
Abstract: Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse reaction to dopamine-antagonist medication that can resemble sepsis. A 51-year-old woman working in healthcare experienced recurrent episodes of fever, confusion and muscle rigidity, with six hospital presentations over approximately 10 months. Her prescribed medicines included promazine and amitriptyline. During an earlier severe admission, she developed hyperthermia, agitation, shock, and a creatine kinase concentration of 7272 U/L, requiring intensive care. Investigations did not identify a unifying diagnosis. During the most recent admission, review of previous records and a non-judgemental discussion elicited possible use of additional medication for sleep and neuropathic pain, although the preparation and quantity remained unclear. Six months' supply of promazine had been approved and dispensed within the preceding three months, supporting increased access without establishing the amount ingested. The clinical pattern supported a working diagnosis of probable promazine-associated NMS, with possible concomitant amitriptyline toxicity. Promazine was discontinued three days after admission. At follow-up approximately six months later, the patient remained off promazine and reported sustained symptom resolution and no further hospital attendances. This case highlights the importance of considering NMS in unexplained fever during antipsychotic treatment, conducting repeated medication reviews, and asking sensitive questions, regardless of a patient's professional healthcare background.
Source: Cureus
Authors: Simonas Makstutis, Suzy Collins
Institution: Stockport NHS Foundation Trust
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225378295