Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of the use of neuroleptic medications. It is of interest to emergency physicians because rapid recognition of NMS will improve patient outcome and prevent inappropriate treatment. NMS shares features with malignant hyperthermia, serotonin syndrome, lethal catatonia, and heat stroke. We describe a patient with NMS who presented to our institution without initial fever. We review the literature, the classic presentation of NMS, the risk factors, and the morbidity. We discuss the differential diagnosis and the treatment recommendations from the literature.