Ohta Ryuichi, Sano Chiaki
Communiy Care, Unnan City Hospital, Unnan, JPN.
Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.
Cureus. 2022 Feb 21;14(2):e22468. doi: 10.7759/cureus.22468. eCollection 2022 Feb.
Serotonin syndrome is a rare complication occurring in patients with psychiatric disorders that are treated with selective serotonin reuptake inhibitors (SSRIs). There are various triggers for serotonin syndrome, including non-SSRI antidepressants. In rare cases, serotonin syndrome may be triggered by nonmedicinal foods, such as coffee. The patient described in this case report was a 65-year-old woman with a past medical history of major depression and a diagnosis of Parkinson's disease who presented to our medical center with chief complaints of nausea, vomiting, and drowsiness. She had previously been prescribed paroxetine hydrochloride hydrate for depression, and she was prescribed levodopa and carbidopa for Parkinson's disease. She also drank 20 cups of coffee in a short period of time two days prior to admission due to excessive sleepiness. She was diagnosed with serotonin syndrome based on her clinical symptomology, which included diaphoresis, mydriasis, fine tremor, myoclonus, hypertension, and tachycardia. She was treated with diazepam and cyproheptadine hydrochloride hydrate. Later, she experienced muscle pain with increased creatinine kinase levels after she failed to take levodopa and carbidopa. These findings were suggestive of neuroleptic malignant syndrome. The patient was treated with supportive care. Excessive coffee intake triggers serotonin syndrome by promoting 5-hydroxytryptamine (serotonin) secretion. Patients with psychiatric diseases that necessitate treatment with SSRIs should be educated regarding caffeine consumption. Moreover, patients presenting with agitation and drowsiness should be evaluated for serotonin syndrome within the differential diagnosis. Patients with depression and Parkinson's syndrome should be evaluated for associated comorbidities, particularly serotonin syndrome and neuroleptic malignant syndrome.
血清素综合征是一种罕见的并发症，发生于接受选择性血清素再摄取抑制剂（SSRI）治疗的精神疾病患者中。血清素综合征有多种诱发因素，包括非SSRI类抗抑郁药。在罕见情况下，血清素综合征可能由非药用食物诱发，如咖啡。本病例报告中的患者是一名65岁女性，有重度抑郁症病史且被诊断为帕金森病，因恶心、呕吐和嗜睡为主诉前来我们的医疗中心就诊。她之前因抑郁症被开了盐酸帕罗西汀水合物，因帕金森病被开了左旋多巴和卡比多巴。入院前两天，由于过度嗜睡，她在短时间内喝了20杯咖啡。基于她的临床症状，包括多汗、瞳孔散大、细微震颤、肌阵挛、高血压和心动过速，她被诊断为血清素综合征。她接受了地西泮和盐酸赛庚啶水合物治疗。后来，她在未服用左旋多巴和卡比多巴后出现肌肉疼痛且肌酸激酶水平升高。这些发现提示为抗精神病药恶性综合征。患者接受了支持性治疗。过量摄入咖啡通过促进5-羟色胺（血清素）分泌诱发血清素综合征。对于需要用SSRI治疗的精神疾病患者，应就咖啡因摄入进行教育。此外，对于出现烦躁和嗜睡的患者，应在鉴别诊断中评估是否为血清素综合征。对于患有抑郁症和帕金森综合征的患者，应评估相关合并症，特别是血清素综合征和抗精神病药恶性综合征。
