Department of Internal Medicine, Magnolia Regional Health Center, Corinth, MS, USA.
Am J Case Rep. 2020 Jun 6;21:e924109. doi: 10.12659/AJCR.924109.
BACKGROUND Serotonin syndrome is a life-threatening condition that involves overstimulation serotonin receptors, which can be caused by medication overdose, drug-drug interactions, and regular doses of medications. It is often an overlooked diagnosis due to the presenting symptoms. CASE REPORT Our patient was a 79-year-old man with a past medical history significant for coronary artery disease status after coronary bypass surgery who presented to the Emergency Department with altered mental status. Vital signs were significant for hyperthermia. On initial assessment, he was only oriented to person and demonstrated shaking rigors. Lab test results were significant for leukocytosis, with troponins 2.94. A chest X-ray revealed left lower-lobe opacification. He was initially treated for community-acquired pneumonia and his elevated troponin required further work up. He was moved to the Intensive Care Unit (ICU) due to worsening respiratory distress, shaking tremors, and confusion. His troponins remained elevated. On his third day of hospitalization, his rigors had improved, but clonus was present. A medication review revealed the patient was on sertraline. He was started on cyproheptadine. The next morning, his mental status had improved to alert and oriented, and his condition returned to baseline. Upon discharge to a rehab facility, sertraline was discontinued. CONCLUSIONS Serotonin syndrome is a condition that is often not initially recognized. Our patient had multiple health problems and presented with altered mental status and tremors, and serotonin syndrome was not recognized until a full neurological exam and medication review had been done. It is important for physicians to be aware of serotonin syndrome as a differential diagnosis, as the symptoms can be masked by other presenting symptoms.
血清素综合征是一种危及生命的病症，涉及到血清素受体过度刺激，这可能是由药物过量、药物相互作用和常规剂量的药物引起的。由于其表现症状，这种疾病常常被忽视。
我们的患者是一位 79 岁的男性，有冠状动脉疾病病史，曾接受过冠状动脉搭桥手术后，因精神状态改变而到急诊就诊。生命体征表现为高热。初步评估时，他仅能定向到个人，并表现出震颤性肌阵挛。实验室检查结果显示白细胞增多，肌钙蛋白为 2.94。胸部 X 光片显示左下肺叶混浊。他最初被诊断为社区获得性肺炎，由于肌钙蛋白升高，需要进一步检查。由于呼吸窘迫、震颤性抽搐和意识混乱加重，他被转至重症监护病房（ICU）。他的肌钙蛋白持续升高。在住院的第三天，他的肌阵挛有所改善，但出现了阵挛。药物审查显示患者正在服用舍曲林。他开始服用赛庚啶。第二天早上，他的精神状态有所改善，意识清醒，病情恢复到基线。在出院到康复机构时，停用了舍曲林。
血清素综合征是一种常常最初未被识别的病症。我们的患者有多种健康问题，表现为精神状态改变和震颤，但直到进行了全面的神经系统检查和药物审查后，才发现了血清素综合征。医生有必要将血清素综合征作为一种鉴别诊断，因为其症状可能会被其他表现症状所掩盖。
