Neuroleptic malignant syndrome is a rare but potentially life-threatening complication of antipsychotic medication use, characterized by dopamine receptor blockade in the central nervous system. First described in the 1960s following the introduction of neuroleptics, its reported incidence ranges from 0.02% to 3.3% of cases, typically appearing within the first weeks of treatment. We report the case of a 46-year-old male patient who presented with marked deterioration of general condition shortly after initiating high-dose levomepromazine for a depressive episode. He was receiving the oral solution at a concentration of 40 mg/mL (1 drop = 1 mg), with a total daily dose of 600 mg. He was emergently hospitalized in the medical intensive care unit following the onset of neuropsychiatric symptoms including anorexia, altered consciousness, rigidity, dyskinetic movements, and sialorrhea, associated with digestive symptoms such as nausea and vomiting, all occurring in a febrile context. On admission, clinical examination revealed a patient in shock with hypotension at 80/40 mmHg, anuria, and profuse sweating. The patient was unconscious with a Glasgow Coma Scale score of 9/15 and bilateral mydriasis. Laboratory findings revealed bicytopenia with anemia at 8 g/dL and thrombocytopenia at 33,000/mm³, severe acute kidney injury with creatinine clearance of 10 mL/min, hepatic cytolysis with a prothrombin time of 50%, and rhabdomyolysis with markedly elevated muscle enzymes including CPK at 60,000 IU/L and LDH at 1,500 IU/L. Fundoscopic examination showed stage I changes. Lumbar puncture was unremarkable, and all cytobacteriological examinations of urine, blood, and stool for infectious agents were negative. The diagnosis of neuroleptic malignant syndrome was established based on Levenson's criteria with 3 major and 6 minor criteria, although likely delayed, and no specific treatment was administered. The acute kidney injury was secondary to rhabdomyolysis in a patient with multiorgan failure including respiratory distress and hepatic failure, associated with disseminated intravascular coagulation.  Continuous renal replacement therapies would have been of great benefit for this patient, but were not available at the time. Despite initial hemodialysis sessions, the patient's condition continued to deteriorate, and he died 15 days after admission following seven daily hemodialysis sessions. The pathophysiology and specific treatment of neuroleptic malignant syndrome remain poorly understood. General supportive measures, discontinuation of the offending neuroleptic agent, and management of complications remain the mainstay of treatment.