Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening condition that has been reported in some patients following the administration of anti-dopaminergic agents or the rapid withdrawal of dopaminergic medications. Here, we report a case of a hypertensive male in his 60s who presented with fever, altered sensorium, rigidity, tremors, constipation, and significant abdominal distension. He had been on procyclidine 5 mg twice daily for 3 years, which was abruptly discontinued 10 days prior. Laboratory investigations revealed elevated creatinine phosphokinase, hypokalemia, and neutrophilic leukocytosis. Imaging showed massive bowel distension without signs of mechanical obstruction. A diagnosis of NMS was established based on Levenson’s criteria. Despite initial conservative management and optimization, the patient succumbed, highlighting a rare and fatal presentation of NMS following procyclidine withdrawal and presenting with paralytic ileus.