Recurrent Unexplained Fever and Suspected Promazine Toxicity: Why Probable Neuroleptic Malignant Syndrome Was Left Undiagnosed in a Healthcare Worker.
- 1Acute Internal Medicine, Stockport NHS Foundation Trust, Manchester, GBR.
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.
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BibTeX
@article{makstutis2026recurrent,
title = {{Recurrent Unexplained Fever and Suspected Promazine Toxicity: Why Probable Neuroleptic Malignant Syndrome Was Left Undiagnosed in a Healthcare Worker.}},
author = {Simonas Makstutis and Suzy Collins},
journal = {Cureus},
year = {2026},
month = nov,
doi = {10.7759/cureus.119209},
url = {https://europepmc.org/article/MED/42999903},
note = {CC BY},
}
RIS
TY - JOUR
TI - Recurrent Unexplained Fever and Suspected Promazine Toxicity: Why Probable Neuroleptic Malignant Syndrome Was Left Undiagnosed in a Healthcare Worker.
AU - Simonas Makstutis
AU - Suzy Collins
PY - 2026
DA - 2026/11/05
JO - Cureus
DO - 10.7759/cureus.119209
UR - https://europepmc.org/article/MED/42999903
AB - 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.
SN - 2168-8184
ER -