An Atypical Presentation of Serotonin Syndrome.

Eric Landa,Angdi Liu,Diana Jung,Abilash Makkar,Stephen Wagner

doi:10.7759/cureus.13377

Abstract

The purpose of this paper is to highlight an uncommon presentation of serotonin syndrome and discuss important points such as causes, the manifestation of symptoms, and available treatments. The report highlights the importance of recognizing typical signs and symptoms in order to uncover an atypical presentation of serotonin syndrome. Serotonin toxicity can become life-threatening if not identified early in its course and the offending agents discontinued. This can be achieved by educated physicians and careful prescribing of these agents.

Highlights

Serotonin syndrome is caused by an excess of serotonergic agonism at receptors in both the central and peripheral nervous system, leading to the manifestation of a wide variety of symptoms from very mild to life-threatening
What if a physician encounters a patient that does not quite fit the picture of serotonin toxicity? we present a case of a 67-year-old female with an atypical presentation of serotonin syndrome due to concurrent lithium toxicity
A clonus could be elicited on her feet, and she had deep tendon hyperreflexia along with muscle rigidity on both her ankles. It was at this point that we realized that she had serotonin syndrome, and cyproheptadine was initiated

Summary

Introduction

Serotonin syndrome is caused by an excess of serotonergic agonism at receptors in both the central and peripheral nervous system, leading to the manifestation of a wide variety of symptoms from very mild to life-threatening. A 67-year-old female with a significant medical history of depression and bipolar disorder (last manic episode in July) presented to the emergency department (ED) with her husband due to a fall. The patient was alert and oriented only to self (AOx1), drowsy in appearance with a mild tremor in the upper extremities, mainly on the hands. Her lithium medication was discontinued, and she was started on normal saline at 75mL/hr. The diagnosis of serotonin syndrome at first eluded us due to the lack of agitation that is commonly seen as a presenting symptom This was masqueraded by the concomitant presence of lithium toxicity

Discussion

Conclusions

Disclosures

Sarko J

Martin TG