Doxylamine Overdose in Teenager with Incidental Pituitary Apoplexy: Case Report

Abstract

Altered mental status and fever in a teenager can be a challenging diagnostic dilemma and thus requires a detailed history and a broad differential diagnosis and workup. A teenager presented with altered mental status and fever was found incidentally to have a pituitary hemorrhage (pituitary apoplexy) but ultimately diagnosed with doxylamine intoxication. Doxylamine, an antihistamine commonly included in sleep aids, toxicity may present with fever and altered mental status and may result in a false positive methadone result on urine toxicology studies due to interference with immunoassay-based drug kits. Pituitary apoplexy is a rare complication of pituitary tumors, usually presenting with headache, visual impairment, and corticotropic abnormalities but not typically associated with altered mental status or impaired consciousness. Although it has the potential for serious sequelae, presentations in pediatric patients have been more subacute.