Case Report

Can Neutrophil-Lymphocyte Ratio Be a Useful Criterion for Neuroleptic Malignant Syndrome in the Absence of Leukocytosis?


Objective: Neuroleptic malignant syndrome (NMS) is a rare but severe side effect of antipsychotic medication. Neutrophil-lymphocyte ratio (NLR) is a simple marker used to measure systemic inflammation.

Method: In this case report we explore the relationship of inflammation in the etiology of NMS. In our case involving NMS, although there was no leukocytosis, the NLR was increased up to systemic infection levels.

Conclusion: We hypothesized that systemic inflammation may take a role in developing NMS. If so, NLR could be a new marker of NMS that may be able to provide more sensitive results than leukocyte levels.


Ananth J, Aduri K, Parameswaran S, Gunatilake S. Neuroleptic malignant syndrome: risk factors, pathophysiology, and treatment. Acta Neuropsychiatr. 2004;16(4):219-28.
2. Jahan MS, Farooque AI, Wahid Z. Neuroleptic malignant syndrome. J Natl Med Assoc. 1992;84(11):966-70.
3. Rosebush PI, Mazurek MF. Serum iron and neuroleptic malignant syndrome. Lancet. 1991: 20;149–51.
4. Rosebush PI, Anglin RE, Richards C, Mazurek MF. Neuroleptic malignant syndrome and the acute phase response. J Clin Psychopharmacol. 2008;28(4):459-61.
5. Anglin RE, Rosebush PI, Mazurek MF. Neuroleptic malignant syndrome: a neuroimmunologic hypothesis. Cmaj. 2010;182(18):E834-8.
6. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
7. Kalelioglu T, Akkus M, Karamustafalioglu N, Genc A, Genc ES, Cansiz A, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder. Psychiatry Res. 2015;228(3):925-7.
8. Mert DG, Terzi H. Mean platelet volume in bipolar disorder: the search for an ideal biomarker. Neuropsychiatr Dis Treat. 2016;12:2057-62.
9. Semiz M, Yildirim O, Canan F, Demir S, Hasbek E, Tuman TC, et al. Elevated neutrophil/lymphocyte ratio in patients with schizophrenia. Psychiatr Danub. 2014;26(3):220-5.
10. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12.
11. Gürol G, Çiftci İ H, Terizi HA, Atasoy AR, Ozbek A, Köroğlu M. Are there standardized cutoff values for neutrophil-lymphocyte ratios in bacteremia or sepsis? J Microbiol Biotechnol. 2015;25(4):521-5.
12. Karamustafalioglu N, Kalelioglu T, Celikel G, Genc A, Emul M. Clinical utility of neutrophil-lymphocyte ratio in the diagnosis of neuroleptic malignant syndrome. Nord J Psychiatry. 2019;73(4-5):288-92.
IssueVol 16 No 3 (2021) QRcode
SectionCase Report(s)
Antipsychotic Agents Inflammation Lymphocyte Neuroleptic Malignant Syndrome Neutrophil

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Kalelioglu T, Celikel G, Balaban O, Karamustafalioglu N, Kim Penberthy J. Can Neutrophil-Lymphocyte Ratio Be a Useful Criterion for Neuroleptic Malignant Syndrome in the Absence of Leukocytosis?. Iran J Psychiatry. 2021;16(3):370-373.