Neuroleptic malignant syndrome in a patient with COVID-19 and the possible role of SARS-CoV-2 in its manifestation: case report and overview of published cases.

Background: The manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is more complex than that of pulmonary infection, and neuropsychiatric symptoms play a role in this complexity. In this paper, we present the case of a 29-year-old schizophrenic patient who suffered from neuroleptic malignant syndrome (NMS) that developed during coronavirus disease 2019 (COVID-19) infection, with an emphasis on the possible connection between these two conditions. Additionally, we provide an overview of published NMS cases in patients with COVID-19 or after vaccination against SARS-CoV-2.

Case presentation: A 29-year-old patient treated for schizophrenia, treated with paliperidone palmitate (150 mg every four weeks) and cariprazine (6 mg daily), was admitted to the hospital for agitation and aggressivity; shortly after arrival at the hospital, laryngospasm and hypoxia occurred. The patient tested positive for SARS-CoV-2, and later, he developed pneumonia. During hospitalization, olanzapine (20 mg daily) was added to his regimen. However, due to continuing restlessness, haloperidol was administered (20 mg over the course of one day). A few days later, neuroleptic malignant syndrome occurred. He was treated with bromocriptine (15 mg daily) and clonazepam (2 mg daily) and recovered.

Conclusions: As SARS-CoV-2 is known to interact with angiotensin-converting enzyme 2 and DOPA-decarboxylase is known to be coexpressed with this receptor, we hypothesized that COVID-19 infection might play a substantial role in the development of NMS.