Slow on the Uptake, Progression to Heartbreak

Abstract

The prevalence of serotonin syndrome increases over the past several years as more serotonergic medications are being used in clinical practice. It is a potentially lethal condition caused by excessive serotonergic activity. Common causes of serotonin syndrome are the use of prescription medications, illicit drugs, or a combination of substances, leading to an increase in the activity of serotonin in the central and peripheral nervous system. The clinical symptoms range from mild to severe. We report a case of a 25-year-old woman with polysubstance abuse, including cocaine, who presented with confusion, rigidity, high-grade fever, and reduced biventricular function on echocardiogram. Based on the combination of substance used history, clinical presentation, and echocardiogram findings, she was diagnosed with serotonin syndrome complicated by takotsubo cardiomyopathy. She improved after being treated in the intensive care unit and was discharged from the hospital. This patient demonstrates the importance of recognizing and promptly initiating management of serotonin syndrome in order to improve morbidity and mortality.

Serotonin Syndrome: The Role of Pharmacology in Understanding Its Occurrence

“…Symptoms are also used to guide the differential diagnosis of the two syndromes; for example: in NMS, patients may have stiffness, rhabdomyolysis (characterized by muscle fiber destruction), and increased serum creatine phosphokinase (CPK) levels, which should not occur in SS [90]. However, some SS case reports show that patients present rigidity, sometimes associated with hyperreflexia [91][92][93][94] and increased serum CPK levels [92,95,96]. In the meta-analysis carried out by Werneke et al (2016), with all cases of SS published in the PubMed databases and Thomson Reuter's Web of Science from 2004 to 2014, they observed that in the 299 cases of SS included in the study, 45.4% (136 cases) had stiffness, and 14% had rhabdomyolysis (42 cases) [5].…”