{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:05:46Z","timestamp":1784801146643,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T00:00:00Z","timestamp":1690934400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>In some patients, neuroleptic malignant syndrome is accompanied significant high levels of erythrocyte sedimentation rate (ESR), C\u2010reactive protein (CRP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Neuroleptic malignant syndrome (NMS) is an idiosyncratic life\u2010threatening adverse reaction and usually triggered in response to antipsychotic drugs. In addition, leukocytosis and increased muscle enzymes levels (especially creatine phosphokinase) are observed in NMS. In addition, a transient increase in different types of acute phase reactants in NMS has been mentioned. This article describes a woman treated with haloperidol, perphenazine, escitalopram, and alprazolam because she developed catatonic symptoms after psychological stress. She suffered from NMS symptoms and had elevated CRP and ESR levels, among other signs and symptoms. Given the COVID\u201019 pandemic and reports of co\u2010occurrence of catatonia and NMS and COVID\u201019 and elevated erythrocyte sedimentation rate (ESR) and C\u2010reactive protein (CRP), this patient was a diagnostic dilemma. After consultation with the consultation\u2010liaison psychiatry units, she was managed adequately with electroconvulsive therapy and lorazepam.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.7734","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T04:40:37Z","timestamp":1691037637000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The diagnostic dilemma in a patient with neuroleptic malignant syndrome during the <scp>COVID<\/scp>\u201019 pandemic: A significant increase in acute phase reactants"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6872-481X","authenticated-orcid":false,"given":"Forouzan","family":"Elyasi","sequence":"first","affiliation":[{"name":"Sexual and Reproductive Health Research Center, Psychiatry and Behavioral Sciences Research Center Addiction Institute, Mazandaran University of Medical Sciences  Sari Iran"},{"name":"Department of Psychiatry, Faculty of Medicine Mazandaran University of Medical Sciences  Sari Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7027-0992","authenticated-orcid":false,"given":"Mehran","family":"Zarghami","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine Mazandaran University of Medical Sciences  Sari Iran"},{"name":"Psychiatry and Behavioral Sciences Research Center Addiction Institute, Mazandaran University of Medical Sciences  Sari Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arghavan","family":"Fariborzifar","sequence":"additional","affiliation":[{"name":"Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine Iran University of Medical Sciences  Tehran 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