Incipient neuroleptic malignant syndrome with quetiapine/paroxetine combination treatment: atypical presentation and early, successful rechallenge with olanzapine.

A 26-year-old caucasian male developed incipient neuroleptic malignant syndrome (NMS) during the course of paranoid schizophrenia with catatonic signs at admission, while on quetiapine/paroxetine combination treatment. The clinical presentation was "atypical", but increased creatine kinase levels and positive myoglobinemia were highly suggestive of the diagnosis. Of note, the patient was successfully rechallenged with olanzapine.