Healthcare Worker Hospitalized Six Times Over Ten Months Before Rare Syndrome Diagnosis
A 51-year-old healthcare worker experienced six hospital admissions over a 10-month period for recurrent episodes of fever, confusion, and severe muscle rigidity before clinicians identified the cause as neuroleptic malignant syndrome, Cureus reported. The patient, who was prescribed promazine and amitriptyline for anxiety, chronic neuropathic pain, and other conditions, presented to the emergency department on her most recent admission with a temperature of 39.4°C and a heart rate of 126 beats per minute. Medical records showed her symptoms often mirrored sepsis, leading to repeated empirical antibiotic treatments and extensive diagnostic evaluations that initially failed to yield a unifying diagnosis. During an earlier severe admission approximately six months prior to her latest hospital visit, the patient developed extreme agitation, vomiting, a temperature exceeding 40°C, and a creatine kinase concentration of 7,272 U/L. That episode required intensive care admission, vasopressor support, and approximately 10 liters of intravenous fluid replacement within the first 24 hours. Electrocardiogram results from that severe admission revealed sinus tachycardia at 151 beats per minute and a prolonged Fridericia-corrected QT interval of 490 ms. Despite extensive microbiological, autoimmune, and cerebrospinal fluid investigations during that stay, clinicians established no definitive cause for her systemic deterioration. Medical teams uncovered the underlying medication toxicity during her latest admission through a detailed review of previous hospital and pharmacy records combined with a non-judgmental discussion regarding additional drug use for sleep and neuropathic pain. Pharmacy data showed that a six-month supply of promazine had been approved and dispensed within a three-month window, pointing to increased access to the medication. Clinicians diagnosed probable promazine-associated neuroleptic malignant syndrome alongside possible concomitant amitriptyline toxicity. At a follow-up appointment six months later, the patient remained off promazine and reported sustained symptom resolution with no further hospital visits.
Frequently Asked Questions
What is neuroleptic malignant syndrome?
Neuroleptic malignant syndrome is a rare and potentially fatal adverse reaction associated principally with dopamine-antagonist medications such as antipsychotics, characterized by pyrexia, altered mental state, severe muscle rigidity, and autonomic instability. In this patient’s case, the condition was linked to promazine use and complicated by repeated hospital presentations over a 10-month period.
What specific medications was the patient prescribed?
The patient’s prescribed medications included promazine 50 mg three times daily, amitriptyline 75 mg at night, diazepam, paracetamol, codeine, and asthma inhalers. Review of her records indicated she had access to a six-month supply of promazine dispensed within a preceding three-month period.
How high did the patient’s creatine kinase levels reach during her illness?
During her earlier severe admission approximately six months prior to her final investigated visit, the patient’s creatine kinase concentration spiked to 7,272 U/L. On her most recent admission, her creatine kinase measured 832 U/L twenty-four hours after hospital entry.
Where was this case report initially presented?
This case report was previously presented as a poster at the 2026 Society for Acute Medicine Glasgow conference on October 8, 2026.
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