OBJECTIVE Neuroleptic malignant syndrome (NMS) is a rare life-threatening condition that providers should be cognizant of when prescribing dopamine-receptor antagonists. Atypical antipsychotic agents were initially considered to have a lower risk of inducing the development of NMS compared with conventional antipsychotic. Considerable evidence, however, has suggested that atypical antipsychotics are associated with NMS, including the partial dopamine agonist, aripiprazole. There is growing evidence that other psychotropics, including lithium, cause this condition. Here, the authors present a case of a patient who developed NMS from lithium and aripiprazole and provide a literature review of reported NMS cases with either psychotropic. METHOD AND RESULTS The authors report the case of 60-year-old male patient who developed NMS over a hospital course during which both aripiprazole and lithium were prescribed. In addition, a literature review was performed and a summary of cases of NMS induced by either lithium and/or aripiprazole is provided. CONCLUSIONS This case adds to the growing body of literature of aripiprazole and lithium-induced NMS. Only 2 other cases are reported where concomitant aripiprazole and lithium use lead to NMS. Interestingly, our patient did develop lithium toxicity during hospitalization, but the NMS diagnosis occurred after lithium toxicity resolved. This varies from the other 2 cases where NMS developed despite lithium levels always being therapeutic. Unfortunately, there are more questions than answers surrounding this rare complication involving these 2 psychotropics and clinical vigilance is warranted when using these psychotropics especially in cases where aripiprazole and lithium are used in combination.

中文翻译：

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锂中毒和阿立哌唑使用背景下的抗精神病药恶性综合征一例。

目的 抗精神病药恶性综合征 (NMS) 是一种罕见的危及生命的疾病，医生在开多巴胺受体拮抗剂处方时应认识到这一点。最初认为非典型抗精神病药物与传统抗精神病药物相比，诱发 NMS 的风险较低。然而，大量证据表明非典型抗精神病药物与 NMS 相关，包括部分多巴胺激动剂阿立哌唑。越来越多的证据表明，包括锂在内的其他精神药物也会导致这种情况。在此，作者介绍了一名因服用锂和阿立哌唑而出现 NMS 的患者的病例，并对已报道的使用任何一种精神药物的 NMS 病例进行了文献综述。方法和结果 作者报告了一名 60 岁男性患者在医院接受阿立哌唑和锂治疗期间出现 NMS 的病例。此外，还进行了文献综述，并提供了由锂和/或阿立哌唑诱发的 NMS 病例总结。结论 该案例丰富了阿立哌唑和锂诱导 NMS 的文献数量。仅报告了 2 例阿立哌唑和锂同时使用导致 NMS 的病例。有趣的是，我们的患者在住院期间确实出现了锂中毒，但 NMS 诊断是在锂中毒解决后发生的。这与其他 2 例不同，尽管锂水平始终具有治疗作用，但仍出现 NMS。不幸的是，围绕这种涉及这两种精神药物的罕见并发症，问题多于答案，在使用这些精神药物时，特别是在阿立哌唑和锂联合使用的情况下，需要临床保持警惕。