CASE REPORT Serotonin Syndrome: a Case Report From India

Objective: To report a case of serotonin syndrome, with episodic worsening course, which responded to treatment with cyproheptadine. Case Report: A 56 year old male, was diagnosed as a case of bipolar affective disorder, hypertension and generalized seizure disorder. While receiving a combination of lithium carbonate 750 mg/d, amlodipine 10 mg/d, phenytoin 300mg/d, sertraline 100 mg/d, trazodone 100mg/d, and escitalopram 10mg/d for 1 week presented with abrupt onset symptoms of 4 days duration, episodic in nature, characterized by confusion, perseveration, shivering, coarse tremors of extremities, perioral and tongue tremors; marked diaphoresis, rigidity, dysarthria, ataxia, occurring once in a day, during the evening hours lasting for few hours. On examination patient was found to have tachycardia (120/min), tachypnea (24/ min), malignant hypertension (230/130 mmHg), marked diaphoresis, generalized tremors, cold extremities, marked rigidity in all four limbs, hyperreflexia, bilateral patellar clonus and dysarthria. He was treated with supportive therapy in the form of monitoring of vitals and fluid balance along with cyproheptadine. Conclusion: In most cases of serotonin syndrome the initial symptoms are of mild intensity and are missed. The initial symptoms can run an episodic course and high index of suspicion is required for accurate diagnosis as prompt discontinuation of the causative agents can have profound impact on the clinical course and outcome of this particular toxic syndrome (German J Psychiatry 2007; 10: 100-102).