title: Serotonin syndrome presenting as pulmonary edema.
abstract: Serotonin syndrome (SS) is a potentially life-threatening condition resulting from excessive central and peripheral serotonergic activity. Clinically, it is a triad of mental-status changes, neuromuscular abnormalities, and autonomic disturbances. It can be caused by intentional self-poisoning, overdose, or inadvertent drug interactions. We report the case of a 58-year-old male with type 2 diabetes mellitus and obsessive compulsive disorder who developed pulmonary edema as a possible complication of SS. SS was caused by a combination of three specific serotonin re-uptake inhibitors (fluoxetine, fluvoxamine, and sertraline), linezolid, and fentanyl. The hospital course was further complicated by difficult weaning from the ventilator. SS was identified and successfully treated with cyproheptadine and lorazepam. The case highlights the importance of effective consultation-liaison and prompt recognition of SS as the presentation may be complex in the presence of co-morbid medical illness.
authors.affiliation: Department of Psychiatry, B.J. Medical College, Ahmedabad, Gujarat, India.
authors.forename: Nilima Deepak
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Private practitioner as pulmonologist at Gujarat Pulmonary and Critical Care Clinic, Ahmedabad, Gujarat, India.
authors.forename: Ajay B
authors.initials: AB
authors.lastname: Jain
mesh_terms: D003533:Cyproheptadine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis*; D020230:Serotonin Syndrome / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D003533:Cyproheptadine
keywords: Fentanyl; linezolid; serotonergic drugs; serotonin syndrome