title: Rare case of severe serotonin syndrome leading to bilateral compartment syndrome.
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.
authors.affiliation: Department of Neurology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Verena
authors.initials: V
authors.lastname: Clarissa Samara
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.|Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Warner
mesh_terms: D000368:Aged; D003161:Compartment Syndromes / Q000209:etiology* / Q000601:surgery*; D000071938:Fasciotomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007866:Leg / Q000473:pathology / Q000601:surgery; D020230:Serotonin Syndrome / Q000150:complications*; D013530:Surgical Wound Infection / Q000188:drug therapy; D016896:Treatment Outcome