A BSTRACT Fever is a common symptom encountered in clinical practice. Hyperthermia, though infrequently encountered, can be genetical (malignant hyperthermia) or acquired when the body temperature rises beyond a certain set point that is controlled by the hypothalamus. We report a case of an elderly male who reported to us with hyperthermia, accelerated hypertension, and brain haemorrhage (as a sequelae of uncontrolled hypertension). A thorough clinical history pointed towards neuroleptic malignant syndrome (NMS). A remarkable response was observed with dantrolene and bromocriptine along with the discontinuation of the offending drug. With conservative management, the patient had complete recovery. This case highlights the importance of even sub-therapeutic drug dosage, particularly neuropsychiatric drugs, in the development of neurological catastrophe.

Nausea and vomiting constitute one of the most common presenting symptoms in a variety of diseases in clinical practice. Recurrent vomiting can be due to simple gastritis which may lead to dehydration and electrolyte disturbances to threatening intracranial hypertension. Prolonged recurrent vomiting can also lead to malnutrition. Esophageal dysmotility is usually associated with dysphagia but is infrequently associated with recurrent vomiting. We report a case of acute-onset intractable vomiting in a 50-year-old Indian female who presented with severe dehydration and hypernatremia. A timed barium esophagogram revealed dilated esophagus with a rat-tail appearance. Upper gastrointestinal endoscopy revealed dilated esophagus with a tight esophageal-gastric junction. With a diagnosis of achalasia cardia, the patient underwent peroral endoscopic myotomy with complete resolution of symptoms.