Rare case of severe serotonin syndrome leading to bilateral compartment syndrome. |
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Abstract | The term 'serotonin syndrome' describes a constellation of symptoms caused by serotonergic overstimulation. Its characteristic clinical presentation consists of encephalopathy, neuromuscular signs and autonomic hyperactivity. After removal of the offending agent, the clinical course is usually self-limited but can occasionally lead to severe symptoms. We report the case of a 68-year-old woman who presented emergently with encephalopathy. Home medications included paroxetine and dextroamphetamine/amphetamine. Physical examination revealed tachycardia, tachypnoea, diaphoresis, rigidity, hyperreflexia and clonus. Given the fast onset of symptoms, a diagnosis of serotonin syndrome was made. Laboratory studies showed acute-on-chronic kidney injury and elevated creatine kinase. The patient's mental status quickly returned to baseline with supportive care. Her rhabdomyolysis, however, persisted and led to acute compartment syndrome in her lower extremities. After bilateral leg fasciotomies and treatment of a severe wound infection with intravenous antibiotics, the patient has now recovered with complete resolution of her symptoms. |
PMID | 28258180 |
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Journal Title | bmj case reports |
Publication Year Start | 2017-01-01 |
PMID- 28258180 OWN - NLM STAT- MEDLINE DA - 20170304 DCOM- 20170313 LR - 20170313 IS - 1757-790X (Electronic) IS - 1757-790X (Linking) VI - 2017 DP - 2017 Mar 03 TI - Rare case of severe serotonin syndrome leading to bilateral compartment syndrome. LID - bcr2016218842 [pii] LID - 10.1136/bcr-2016-218842 [doi] AB - The term 'serotonin syndrome' describes a constellation of symptoms caused by serotonergic overstimulation. Its characteristic clinical presentation consists of encephalopathy, neuromuscular signs and autonomic hyperactivity. After removal of the offending agent, the clinical course is usually self-limited but can occasionally lead to severe symptoms. We report the case of a 68-year-old woman who presented emergently with encephalopathy. Home medications included paroxetine and dextroamphetamine/amphetamine. Physical examination revealed tachycardia, tachypnoea, diaphoresis, rigidity, hyperreflexia and clonus. Given the fast onset of symptoms, a diagnosis of serotonin syndrome was made. Laboratory studies showed acute-on-chronic kidney injury and elevated creatine kinase. The patient's mental status quickly returned to baseline with supportive care. Her rhabdomyolysis, however, persisted and led to acute compartment syndrome in her lower extremities. After bilateral leg fasciotomies and treatment of a severe wound infection with intravenous antibiotics, the patient has now recovered with complete resolution of her symptoms. CI - 2017 BMJ Publishing Group Ltd. FAU - Clarissa Samara, Verena AU - Clarissa Samara V AD - Department of Neurology, University of Utah, Salt Lake City, Utah, USA. FAU - Warner, Judith AU - Warner J AD - University of Utah, Salt Lake City, Utah, USA. AD - Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. LA - eng PT - Case Reports PT - Journal Article DEP - 20170303 PL - England TA - BMJ Case Rep JT - BMJ case reports JID - 101526291 SB - IM MH - Aged MH - Compartment Syndromes/*etiology/*surgery MH - Fasciotomy/adverse effects/methods MH - Female MH - Humans MH - Leg/pathology/surgery MH - Serotonin Syndrome/*complications MH - Surgical Wound Infection/drug therapy MH - Treatment Outcome EDAT- 2017/03/05 06:00 MHDA- 2017/03/14 06:00 CRDT- 2017/03/05 06:00 AID - bcr-2016-218842 [pii] AID - 10.1136/bcr-2016-218842 [doi] PST - epublish SO - BMJ Case Rep. 2017 Mar 3;2017. pii: bcr2016218842. doi: 10.1136/bcr-2016-218842.
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