SESSION TITLE: Critical Care 4 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Neuroleptic malignant syndrome (NMS) is a rare life-threatening neurologic emergency characterized by mental status changes, rigidity, fever, and dysautonomia. The incidence rate of NMS is 0.02-3% among patients taking typical or atypical neuroleptic agents; however, clozapine-induced NMS is a rarely-reported and unique entity as it doesn’t present with the four cardinal clinical features of NMS. We present a rare case of clozapine-induced NMS with the four cardinal features of NMS. CASE PRESENTATION: A 45-year-old man with history of schizoaffective disorder and catatonia was transferred from a local psychiatric hospital to the emergency department (ED) for evaluation of fever and altered mental status. Two days prior to the transfer, he was started on clozapine. In the ED, he had a temperature of 39.1° Celsius, blood pressure of 100/57 mmHg, respiratory rate of 24 breaths-per-minute, and heart rate of 118 beats-per-minute. The patient was diaphoretic, drooling, and shivering. He was lethargic with Glasgow Coma Scale of 8 and was therefore intubated. At that point, the rest of the examination was non-significant. Initial laboratory work-up including creatinine phosphokinase (CPK) was non-significant. Computed tomography (CT) scan of the head was normal. Lumbar puncture was performed and cerebrospinal fluid analysis was unremarkable. The patient was admitted to the intensive care unit (ICU) where he continued to develop fevers despite the use of antipyretics, cooling blankets, an d aggressive intravenous hydration. The fever spikes were associated with intermittent episodes of sinus tachycardia and fluctuations of his blood pressure. On day two, he developed rigidity, and blood work-up was significant for CPK level of 4419 U/L. He was started on benzodiazepines and dantrolene for a presumed diagnosis of NMS. However, his rigidity and fever didn’t improve. On day four, he developed ventilator-associated pneumonia. After a week in the ICU with no success in liberation of mechanical ventilation, family decided to shift care to comfort measures only. The patient perished a few hours later. DISCUSSION: Clozapine is considered among the most potent neuroleptic agents, with use reserved for treatment-resistant cases. Although it has many side effects, there are very few case reports about clozapine-induced-NMS. Risk factors for developing clozapine-induced NMS include young age, male gender, and history of catatonia. CONCLUSIONS: It is important to be aware of these risk factors for early recognition and treatment of NMS, given its high mortality rate of 10-30%. Reference #1: Clozapine-induced neuroleptic malignant syndrome: review and report of new cases.P. Sachdev, J. Kruk, M. Kneebone, D. KissaneJ Clin Psychopharmacol. 1995 Oct; 15(5): 365–371. DISCLOSURES: No relevant relationships by Abdullah Chahin, source=Web Response No relevant relationships by Faeq Kukhon, source=Web Response No relevant relationships by Mahmoud Mowafy, source=Web Response No relevant relationships by Magaly Sazani, source=Web Response No relevant relationships by Abraham Walusimbi, source=Web Response