This case highlights a rare instance of alcohol-induced neuroleptic malignant syndrome (NMS) complicated by acute severe rhabdomyolysis, emphasizing the importance of recognizing atypical presentations of NMS. In June 2024, a 22-year-old male presented to the emergency department of a tertiary hospital in Florida with an acute alteration in mental status following alcohol consumption. Physical examination revealed neurological deficits alongside significant vital signs, including a temperature of 38°C, tachycardia, and hypertension. Key laboratory findings included a creatinine phosphokinase (CPK) level exceeding 100,000 U/L, aspartate aminotransferase (AST) above 3,000 U/L, alanine aminotransferase (ALT) above 500 U/L, and a lithium level below 0.20 mmol/L. The patient's medical history of bipolar disorder, managed with lithium, and recent alcohol intake suggest alcohol's role as a trigger for NMS in the context of lithium treatment, compounded by severe rhabdomyolysis. This case underscores the need for heightened clinical awareness of such complex interactions and highlights the critical importance of early recognition and multidisciplinary management to prevent potentially fatal complications.
