# Neuroleptic Malignant Syndrome Following Brexpiprazole Initiation in a Treatment-Resistant Schizophrenia Patient With Influenza A: A Case Report

## TL;DR

A man with treatment-resistant schizophrenia developed a severe psychiatric condition after starting brexpiprazole while infected with influenza A, highlighting the risks and the importance of vaccination.

## Contribution

This case report highlights the rare but serious risk of neuroleptic malignant syndrome with brexpiprazole initiation during influenza A infection in treatment-resistant schizophrenia.

## Key findings

- A treatment-resistant schizophrenia patient developed NMS after starting brexpiprazole during influenza A infection.
- The patient's lack of influenza vaccination and concurrent antipsychotic cross-titration may have contributed to the syndrome.
- The case emphasizes the importance of influenza vaccination and cautious antipsychotic initiation in vulnerable psychiatric patients.

## Abstract

We present a case of a 30-year-old male with a 15-year history of treatment-resistant schizophrenia who developed neuroleptic malignant syndrome (NMS) after the initiation of brexpiprazole in the setting of serology-confirmed influenza A infection. The patient was also receiving maintenance electroconvulsive therapy (ECT) and was undergoing cross-titration of antipsychotics when he developed fever, cough, shortness of breath, tremors, and rigidity. He tested positive for influenza A, and there were no records of any regular influenza vaccination. This case underscores the need for caution in the initiation of antipsychotics, including brexpiprazole, in this group of patients and the potential role of systemic infections in precipitating NMS. Early recognition and prompt intervention are crucial in preventing morbidity and mortality. Furthermore, this case highlights the importance of regular influenza vaccination, particularly in individuals with serious mental illness and on long-term antipsychotic therapy.