TY - JOUR T1 - Coexistence of serotonin syndrome and neuroleptic malignant syndrome: does it exist? JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2021-241578 VL - 14 IS - 8 SP - e241578 AU - Sanjay Prakash AU - Deepali Lodha AU - Kalu Singh Rawat Y1 - 2021/08/01 UR - http://casereports.bmj.com/content/14/8/e241578.abstract N2 - We report a 21-year-old man with bipolar disorder who was on a stable dose of escitalopram and risperidone. Tramadol and cough syrup (dextromethorphan) were added for his recent attack of upper respiratory tract infection. However, he developed various neurological symptoms. Haloperidol and ondansetron were added after hospitalisation. However, his condition deteriorated. A diagnosis of serotonin syndrome (SS) was made, and cyproheptadine was started. Cyproheptadine provided relief in most of the symptoms within 48 hours except for the presence of fever and rigidity. The addition of bromocriptine provided a complete resolution of the symptoms. We considered the presence of both SS and neuroleptic malignant syndrome (NMS) in this case. There are four similar cases in the literature. We discussed a diagnostic and therapeutic approach for patients who are on both serotonergic agents and neuroleptics and develop SS-like or NMS-like clinical features. ER -