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{
    "pk": 47071,
    "title": "A Diagnostic Dilemma—Severe Hyperthermia and Rigidity in a Young Man with Polysubstance Use: A Case Report",
    "subtitle": null,
    "abstract": "<p><strong>Introduction</strong>: Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition often associated with dopamine antagonist use. However, its overlap with other hyperthermic and toxidromic syndromes presents significant diagnostic challenges. We present the case of a 27-year-old man with severe hyperthermia, altered mental status, and diffuse rigidity, ultimately managed as possible NMS but with multiple differential diagnoses.</p>\n<p><strong>Case Report: </strong>We describe a diagnostically challenging case of a 27-year-old male with an unknown medical history presenting with altered mental status, absence of personal identification, severe hyperthermia, and positive systemic inflammatory response syndrome criteria. The patient initially presented with hyperthermia (42.1 °C), tachycardia, tachypnea, diaphoresis, agitation, and rigidity. Initial lab findings demonstrated leukocytosis, elevated creatine kinase, metabolic acidosis, and rhabdomyolysis. Computed tomography ruled out acute anatomical abnormalities, while urine toxicology returned positive for amphetamines and cocaine. The patient required sedation, rapid sequence intubation, and dantrolene administration, which rapidly resolved his rigidity and hyperthermia and stabilized his vital signs. He was admitted to the intensive care unit, where supportive care, including antipyretics, hydration, and muscle relaxants led to gradual improvement. When the patient became less altered, he admitted to a history of aripiprazole use for schizophrenia, as well as daily amphetamine and cocaine use.</p>\n<p><strong>Conclusion</strong>: This case underscores the importance of considering neuroleptic malignant syndrome in patients with atypical presentations, suspicion for comorbid psychiatric conditions, and substance use disorder. Timely diagnosis, discontinuation of the offending agent, and targeted therapies such as dantrolene are critical in preventing complications. We highlight the diagnostic challenges and management strategies for NMS in the context of a limited history and severe hyperthermia.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "neuroleptic malignant syndrome"
        },
        {
            "word": "serotonin syndrome"
        },
        {
            "word": "sympathomimetic toxicity"
        },
        {
            "word": "hyperthermia"
        },
        {
            "word": "altered mental status"
        },
        {
            "word": "case report"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/6kz986f2",
    "frozenauthors": [
        {
            "first_name": "Joseph",
            "middle_name": "P",
            "last_name": "O'Brien",
            "name_suffix": "",
            "institution": "Denver Health, Department of Emergency Medicine, Denver, Colorado",
            "department": ""
        },
        {
            "first_name": "Matthew",
            "middle_name": "",
            "last_name": "Carvey",
            "name_suffix": "",
            "institution": "MetroHealth Medical Center, Department of Emergency Medicine, Cleveland, Ohio",
            "department": ""
        }
    ],
    "date_submitted": "2025-03-23T18:55:07.910000+02:00",
    "date_accepted": "2025-06-17T02:04:36.793000+03:00",
    "date_published": "2025-08-27T08:30:00+03:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/47071/galley/40145/download/"
        }
    ]
}