{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:16:52Z","timestamp":1787019412019,"version":"build-2736575974"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Neuroleptic malignant syndrome (NMS) is a severe adverse reaction associated with neuroleptic or antipsychotic drugs. This case report discusses a 43-year-old man with a history of bipolar disorder and polysubstance abuse who presented with altered mental status, autonomic dysfunction, and muscular rigidity. The patient had recently started on ziprasidone, a second-generation antipsychotic, leading to an atypical presentation of NMS. Unlike classic findings associated with NMS induced by first-generation antipsychotics, this case lacked high fever, lead pipe rigidity, or elevated creatine kinase levels greater than 1000 on initial presentation. The delay in diagnosis was attributed to the milder symptoms and absence of typical findings, resulting in extensive diagnostic workup and interventions. The patient responded positively to treatment with lorazepam based on the Woodbury severity stage guidelines. This case underscores the complexity of diagnosing NMS induced by second-generation antipsychotics and highlights the need for awareness and tailored treatment approaches for atypical presentations.<\/jats:p>","DOI":"10.1177\/23247096241262690","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T02:42:26Z","timestamp":1721788946000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Atypical Presentation of Ziprasidone-Induced Neuroleptic Malignant Syndrome: A Case Report"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4604-8952","authenticated-orcid":false,"given":"John","family":"Allonce","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Naples Community Hospital, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikandar","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Naples Community Hospital, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Pulford","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Naples Community Hospital, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,7,23]]},"reference":[{"key":"bibr1-23247096241262690","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-018-0959-2"},{"key":"bibr2-23247096241262690","doi-asserted-by":"crossref","unstructured":"Velamoor R. Neuroleptic malignant syndrome: a neuro-psychiatric emergency: recognition, prevention, and management. Asian J Psychiatr. 2017;29:106-109. Accessed May 4, 2024. https:\/\/pubmed.ncbi.nlm.nih.gov\/29061403\/","DOI":"10.1016\/j.ajp.2017.05.004"},{"key":"bibr3-23247096241262690","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-64012-3.00025-3"},{"key":"bibr4-23247096241262690","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.10m06438"},{"key":"bibr5-23247096241262690","doi-asserted-by":"publisher","DOI":"10.30773\/pi.2017.06.05"},{"key":"bibr6-23247096241262690","unstructured":"Ero\u011flu E\u00d6, Yildiz M\u0130, Yazici MK. Atypical neuroleptic malignant syndrome induced by low dose quetiapine in a patient treated with Donepezil. Noro Psikiyatri Ars. 2021;58(2):166-168. Accessed May 4, 2024. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8214739\/"},{"key":"bibr7-23247096241262690","doi-asserted-by":"crossref","unstructured":"Niu X, Dennen S, Dembek C, et al. Hospitalization risk for adults with bipolar I disorder treated with oral atypical antipsychotics as adjunctive therapy with mood stabilizers: a retrospective analysis of Medicaid claims data. Curr Ther Res Clin Exp. 2021;94:100629. Accessed May 4, 2024. https:\/\/pubmed.ncbi.nlm.nih.gov\/34306269\/","DOI":"10.1016\/j.curtheres.2021.100629"},{"key":"bibr8-23247096241262690","unstructured":"Bouchette D, Fariba K, Marwaha R. Ziprasidone, StatPearls [Internet]. 2022. Accessed May 4, 2024. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448157\/"},{"key":"bibr9-23247096241262690","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1G470"},{"key":"bibr10-23247096241262690","unstructured":"Simon LV, Hashmi MF, Callahan AL. Neuroleptic malignant syndrome, StatPearls [Internet]. 2023. 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