Open AccessSerotonin syndrome presenting as pulmonary edema
Author(s) -
Nilima D. Shah,
Ajay B Jain
Publication year - 2016
Publication title -
indian journal of pharmacology/the indian journal of pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.286
H-Index - 59
eISSN - 1998-3751
pISSN - 0253-7613
DOI - 10.4103/0253-7613.174575
Subject(s) - serotonin syndrome , medicine , sertraline , serotonergic , pulmonary edema , anesthesia , mirtazapine , fluoxetine , neuroleptic malignant syndrome , mdma , cyproheptadine , venlafaxine , linezolid , complication , lorazepam , serotonin , psychiatry , antidepressant , lung , receptor , hippocampus , genetics , vancomycin , biology , bacteria , staphylococcus aureus
Serotonin syndrome (SS) is a potentially life-threatening condition resulting from excessive central and peripheral serotonergic activity. Clinically, it is a triad of mental-status changes, neuromuscular abnormalities, and autonomic disturbances. It can be caused by intentional self-poisoning, overdose, or inadvertent drug interactions. We report the case of a 58-year-old male with type 2 diabetes mellitus and obsessive compulsive disorder who developed pulmonary edema as a possible complication of SS. SS was caused by a combination of three specific serotonin re-uptake inhibitors (fluoxetine, fluvoxamine, and sertraline), linezolid, and fentanyl. The hospital course was further complicated by difficult weaning from the ventilator. SS was identified and successfully treated with cyproheptadine and lorazepam. The case highlights the importance of effective consultation-liaison and prompt recognition of SS as the presentation may be complex in the presence of co-morbid medical illness.