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Neuroleptic malignant syndrome (NMS) is a rare but serious adverse reaction to antipsychotic drugs. According to studies, the incidence of this syndrome varies between 0.07 and 2.2 percent. The risk of fatal outcome associated with NMS is estimated at 30 percent. Based on a clinical vignette and a recent literature review, in this paper we present a clinical case of atypical malignant syndrome caused by the incriminated molecule paliperidone palmitate, as well as its delayed onset, and its presentation.