title: Serotonin syndrome versus neuroleptic malignant syndrome: a challenging clinical quandary.
abstract: Serotonin syndrome and neuroleptic malignant syndrome are two drug toxidromes that have often overlapping and confusing clinical pictures. We report a case of a young man who presented with alteration of mental status, autonomic instability and neuromuscular hyperexcitability following ingestion of multiple psychiatric and antiepileptic medications. The patient satisfied criteria for serotonin syndrome and neuroleptic malignant syndrome, and based on the characteristic clinical features, laboratory findings and clinical course it was concluded that the patient had both toxidromes. The patient was managed with cyproheptadine and supportive measures, and recovered over the course of 3 weeks. A brief review of literature highlighting the diagnostic clues as well as the importance of recognising and distinguishing the often missed and confounding diagnoses follows.
authors: Department of Medicine, Medical College Baroda, Vadodara, Gujarat, India.
authors: Rupal
authors: R
authors: Dosi
authors: Department of Medicine, Medical College Baroda, Vadodara, Gujarat, India.
authors: Annirudh
authors: A
authors: Ambaliya
authors: Department of Medicine, Medical College Baroda, Vadodara, Gujarat, India.
authors: Harshal
authors: H
authors: Joshi
authors: Department of Medicine, Medical College Baroda, Vadodara, Gujarat, India.
authors: Rushad
authors: R
authors: Patell
mesh_terms: D018692:Antimanic Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects; D002998:Clonazepam / Q000009:adverse effects*; D003937:Diagnosis, Differential; D018757:GABA Modulators / Q000009:adverse effects*; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D000077152:Olanzapine; D018967:Risperidone / Q000009:adverse effects; D020230:Serotonin Syndrome / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D014635:Valproic Acid / Q000009:adverse effects; D055815:Young Adult
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018757:GABA Modulators; D018020:Lithium Compounds; D001569:Benzodiazepines; D002998:Clonazepam; D014635:Valproic Acid; D018967:Risperidone; D000077152:Olanzapine