Neuroleptic malignant syndrome (NMS) is an idiosyncratic drug reaction to antipsychotics and potentially life threatening, which is characterized by the abrupt onset of the tetrad of fever, autonomic instability, extrapyramidal syndrome (EPS) and confused mental state (Trollor et al, 2009). Paliperidone, the major active metabolite of risperidone, is the newest of the second generation antipsychotics shown to be effective in treating schizophrenia. There have been two case reports (Duggal, 2007; Mantas et al., 2010) of NMS associated with paliperidone treatment for schizophrenia. This case report is the third one developed NMS with paliperidone treatment. However, our case report is characterized by adding low paliperidone (6 mg/d) to tapering doses of olanzapine in comparison with the previous two reports (IRB approval number: HC10EESE0070).
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