Serotonin syndrome presenting as pulmonary edema

Area of Science:

• Pharmacology
• Toxicology
• Critical Care Medicine

Background:

• Serotonin syndrome (SS) is a potentially fatal condition due to excessive serotonergic activity, presenting with mental status changes, neuromuscular abnormalities, and autonomic dysfunction.
• Causes include intentional overdose, self-poisoning, or inadvertent drug interactions, highlighting the need for careful medication management.

Observation:

• A 58-year-old male with type 2 diabetes and obsessive-compulsive disorder developed pulmonary edema, a potential complication of SS.
• The SS was triggered by a combination of three SSRIs (fluoxetine, fluvoxamine, sertraline), linezolid, and fentanyl.
• The patient experienced difficult weaning from mechanical ventilation, further complicating his hospital course.

Findings:

• Prompt recognition and treatment of SS with cyproheptadine and lorazepam were crucial for patient recovery.
• The case underscores the complexity of SS presentation in patients with comorbid medical conditions.

Implications:

• This case emphasizes the critical role of consultation-liaison services in managing complex SS cases.
• Early identification and intervention are vital for improving outcomes in patients with serotonin syndrome, especially those with co-existing illnesses.