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Published on: September 23, 2015
A case study of delayed serotonin syndrome: lessons learned
Shannon Pearce1, Nasiva Ahned, Grace M Varas
1University of Texas Health Science Center, Houston, Texas 77030, USA. Shannon.E.Pearce@uth.tmc.edu
Summary
Serotonin syndrome, a dangerous condition from excess serotonin, can occur even with single drug use. This case highlights a senior patient whose symptoms resolved after discontinuing paroxetine.
Area of Science:
- Neuroscience
- Pharmacology
- Clinical Medicine
Background:
- Serotonin syndrome is a severe condition caused by excessive central and peripheral nervous system serotonin agonism.
- While often linked to polypharmacy, other mechanisms can lead to serotonergic excess.
Observation:
- A 79-year-old female presented with altered mental status, chills, anorexia, incontinence, and fever.
- Initial diagnostics ruled out common infections, cardiac events, and stroke.
- Despite aggressive treatment, her delirium worsened over 24 hours.
Findings:
- The patient's symptoms, including confusion and agitation, were initially unexplained.
- Discontinuation of paroxetine led to complete symptom resolution within 48 hours.
- This case suggests paroxetine monotherapy as a potential cause of serotonin syndrome in the elderly.
Implications:
- Highlights the importance of considering serotonin syndrome even with single serotonergic agents, particularly in older adults.
- Emphasizes the need for comprehensive diagnostic evaluation and careful medication review in cases of unexplained delirium.
- Underscores the value of postmarketing surveillance and reporting for identifying rare adverse drug events and drug-drug interactions.
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