Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening idiosyncratic reaction to antipsychotic agents, characterised by hyperthermia, generalised muscular rigidity, altered sensorium, and autonomic instability. We report a 51-year-old male with a 19-year history of schizophrenia on long-term antipsychotic therapy who developed NMS amid acute psychiatric decompensation. Clinical features included high-grade fever, lead-pipe rigidity, acute confusional state, and markedly raised creatine phosphokinase (CPK: 9865 U/L). All antipsychotics were withdrawn immediately, and the patient was managed with bromocriptine, supportive care, and four sessions of Modified Electroconvulsive Therapy (MECT). Serial CPK values fell progressively from 9865 U/L to 112 U/L over the treatment period. Rigidity resolved, sensorium cleared, and haemodynamic parameters normalised. Concurrent right lower zone pneumonia caused by Acinetobacter baumannii was treated with culture-directed antibiotic therapy. This report illustrates the value of MECT as an adjunctive intervention in NMS, particularly in patients requiring long-term psychiatric pharmacotherapy. The patient was discharged after 20 days in a stable condition, with gradual reintroduction of atypical antipsychotics under close observation. Diligent serial monitoring of CPK, inflammatory markers, and clinical parameters is essential throughout NMS management.

KEYWORDS: Neuroleptic Malignant Syndrome (NMS), Modified Electroconvulsive Therapy (MECT), Schizophrenia, Bromocriptine, Antipsychotic, Creatinine Phosphokinase (CPK).