Serotonin syndrome overlapping with neuroleptic malignant syndrome: A case report and approaches for differentially diagnosing the two syndromes.
Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are life-threatening adverse reactions caused by serotonergic antidepressants and neuroleptics, respectively. SS and NMS have overlapping clinical features, and thus differentially diagnosing the syndromes can be difficult in patients who are taking both types of drugs. Here, the author reports a unique case of a patient who developed SS that overlapped with NMS after taking imipramine and lithium carbonate with the subsequent addition of metoclopramide. This is the first case report of SS that overlapped with NMS. The author also briefly summarizes the clinical symptoms of each syndrome and describes the approaches that were used to differentially diagnose the two syndromes.
Department of Psychiatry, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Tochigi, Japan; Nasukohgen Hospital, Tochigi, Japan. Electronic address: midorin@jichi.ac.jp.
Koichi
K
Nisijima
D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000009:adverse effects; D000066491:Clinical Decision-Making; D003533:Cyproheptadine / Q000008:administration & dosage*; D003620:Dantrolene / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000188:drug therapy*; D003937:Diagnosis, Differential; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007099:Imipramine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012702:Serotonin Antagonists / Q000008:administration & dosage; D020230:Serotonin Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
D000929:Antidepressive Agents, Tricyclic; D009125:Muscle Relaxants, Central; D012702:Serotonin Antagonists; D003533:Cyproheptadine; D003620:Dantrolene; D007099:Imipramine
Imipramine; Lithium carbonate; Metoclopramide; Neuroleptic malignant syndrome; Serotonin syndrome